A Comment on Health Care Reform from a Mental Health Provider

I live and work in Alabama. I am currently insured with a Cobra policy from Blue Cross - it was my only option. I also happen to be a health care provider. I am a clinical social worker with a private counseling practice. So I believe I see the health care issue from both sides of the coin. And no matter how I try I cannot see the reason for health insurance to exist at all. No matter what we buy we are always searching to eliminate as many 'middle men' as possible. Insurance companies are for-profit organizations. Just because we have always run our health care system this way doesn't mean we have to continue doing so. But people do not take to change easily. And it's hard to imagine what life would be like if our system had such a major overhaul.

As a clinical social worker in Alabama I cannot be an in-network provider for Blue Cross though I am an in-network provider for every other insurance company nation-wide. To control their mental health expenses Blue Cross has a capitated contract with a state-wide company called Alabama Psychiatric Associates. That means they pay a set fee to this company to provide all psychotherapy services to their enrollees. Whether they see you once or ten times they get the same amount of money. You cannot choose your therapist. If you chose to work for Alabama Psychiatric Associates they require that you abandon your private practice completely. I have chosen to remain in private practice and become creative in the services I offer in order to remain independent. Major companies who can afford to, have given their mental health coverage to other insurance companies. In Alabama the medical coverage offered by Blue Cross is considered good.

That's if you can get a policy. As I said I am currently on a Blue Cross Cobra policy and appreciate the assistance I am getting to pay the premium from the stimulus package. But when my Cobra runs out I will only be able to get coverage through the Alabama High Risk pool because I am diabetic. Blue Cross spends a lot on TV ads for their independent coverage policy. But it is almost impossible to get. The eliminations for preexisting conditions take a tome almost the size of the old encyclopedia Britannica. I'm lucky that Alabama is one of the states that have a high risk pool. Some don't. I am expecting my premium to be about $1000.00 a month. Hopefully before my Cobra runs out there will be an alternative for me.

What is the real cost of health care? Each insurance company sets its own fee scale for procedures and reimburses based on what they say the cost is. Every time we get a bill we see that the insurance company has only paid the allowed amount and we pay our co-pay based on that fee. If you are not insured you will be billed the full amount and receive no discount from the doctor or hospital. So what was the service worth? The full fee? The insurance fee? Or maybe something totally different.

I hate to be the one to say this but the medical industry really needs to be a not-for-profit situation. The goal should be improving health and saving lives. Medicine is making advances in so many diseases every day. Every American should have the opportunity to get the best care that exists for their conditions. The reason they should have this is simple - it's the right thing to do. It seems to me that we are so mired in politics and partisanship that we have forgotten that simple fact. Every human life is precious and short. In a society that believes it is the most advanced and free there should not be a question about qualifying for care. HMO's and PPOs restrict our options as to who you can see for care. We should be able to see whoever we feel can provide us with the best care, not someone who is in-network. Get rid of the network. Let doctors compete for you business based on how well they provide treatment, how well they treat their patients, how quickly they provide service and what they charge. If you aren't good, and fair, and smart and successful people won't go to you. Doctors will no longer have a captive audience based on their in-network affiliation.

I don't know if the plan our President is offering includes all of that but it should. And American's should not fear a change in the system. My job as a therapist is to help people change and so I know the resistance people have to new alternatives. But I tell my patients that there is never one solution to any problem and when one doesn't work you have t seek another. My patients get better. And so can this country.