Though I try to avoid anything political in my blog and in my personal life and few would argue that health care has become a major political hot button issue these past few years, I feel the need to share some frustrations, one clinician to others. This sharing will not be a red versus blue or “us versus them” type of thing, but more a sharing of some weird and unsettling observations. Hopefully someone reading this will be able to help me better understand the “grand scheme of things” when it comes to insurance. In the past several months I have grown more and more exhausted over what I feel is class warfare being waged on the poor, middle class and upper middle class at the hands of insurance companies, corporations and assorted politicians. While premiums continue to rise well above inflation or cost of living adjustments, what is covered is diminishing as well as quality of services. Co pays, deductibles and the like are also going through the roof. While increased costs effect us all as we all pay more, the cost per percentage of income is far more damaging to the poor and middle class than it is to those who are making 120k or more per year. For instance, if someone making $70.00 and hour suddenly has to pay $45.00 a session to see their clinician they likely can afford it without worrying about groceries, rent, mortgage, car payment etc. But what about the person who is making minimum wage or some other modest amount; this new co pay is tantamount to the insurance company saying “stay home, you are fine.” As the clinician we cannot waive copays or deductibles or risk lawsuits and criminal investigations from being launched by the insurance companies for fraud. Sadly, more and more folks are being denied must needed care due to these outrages fees. As a clinician this is the worst part of my job; seeing people leave treatment who are in need because they cannot afford the co pay and knowing that I am powerless to waive the fee. Instead the most I can do is offer a payment plan. The insurance companies tout the astronomical cost of health care in the US and I am sure it is expensive but where exactly is the money going? It is not going to clinicians I can tell you that. Though I am a doctor of counseling I make less per hour than my mechanic charges me for a tune up! In fact, since I have been practicing I have seen one increase in my session rate (two if you count the time I told an insurance company to keep their contract offer due to the abysmal fee scale) and that was for a few dollars. I was told it was the first such adjustment in 20 years, though our premiums increase every year! Where is the money going? While big business talks of tightening belts and streamlining processes to help stop runaway expenses, I see them point out such “selfish” people as school teachers, police, firemen and postal workers. I hear them talk about outrages costs associated with even a 25 cent increase in minimum wage while corporate jets, multimillion dollar bonuses on top of multimillion dollar pay, billion dollar expense accounts and the like are either not mentioned or dismissed as the “only way to get the best and the brightest officers.” It leaves me to wonder not what they think of the average worker but what Axis II diagnosis best fits that mind set. I am not a big city fella, the thought of New York City evokes no thrills in me; give me a patch of blue sky, acres of woodlands and a simple room with comfy furniture and I can get the job done and I am in my glory. Maybe I am not made in a way to properly understand the issues and way of the world in the big city; I cannot argue that with you but I do know how things could be and often are in a world where a person makes their own way by making square deals and working on the level with folks. I know how the world works when a person makes a decision to be fair and not to take advantage of others. For instance, last year when I surprised my wife with a modest art studio at the WIP, I noticed an antique telephone that I thought would be perfect as a display. The owner was not sure what he wanted for it but advised me that he would sell it to me once he did some homework. While waiting for him to come up with a price I did some research of my own and found that they tended to range from 150.00 to 500.00 or more depending on age, condition, brand etc. When the owner advised me that he did not have time to look into the prices but came up with $50.00, I could have tried to talk him down or jump on the offer knowing that I would have been taking advantage of him, or I could do something else. I chose to tell him that I was not interested in the phone for $50 but I would be interested in it for $100, as that way I thought we would both be getting a good deal (I have no idea what it is actually worth but figured that I saw one locally for $125 and would have offered that person $100). The owner looked at me in shock as I told him that I would not take advantage of someone; what was fair was fair. Apparently the bid city, big business folk missed that class. Many years ago I discussed the insurance mess with a group of professionals. I posited in the 1990’s that the problem was not too much coverage but too much emphasis on profit in the managed care field. I proposed the concept of managed care as a not for profit but self sustaining institution; one that focused on quality care, keeping costs and pay realistic and even making a slight profit so the company has money on hand. Gone would be million dollar bonuses, private planes and obscene profits and in its place would be a square deal for all involved. Every worker would get paid a realistic and fair amount but no one would get million dollar pay offs. A few folks thought my idea had merit and several suits told me that I was a hippie, communist, that I hated America etc. They advised me that America was founded on the principle of making maximum profit and to do anything contrary would be tantamount to burning the flag and melting the statue of liberty to make bongs (I love how person and insulting they became). I asked them where the founding fathers had said it was ok to let people die if they could not afford health care. I asked them if the pursuit of happiness and the talk of all men being created equally was the product of hippie bong water or the product of our founding fathers and reminded them that national health care was talked about since the founding of our nation; the thought of equal access to healthcare is not a new concept at all. We live in stupid times. Times where sound bites make right, where if you tell a lie loud enough and often enough it becomes the truth and the person who makes sense is defined and befouled by passionate hate speech and condemnation. Perhaps the nation has behaviors that would be consistent with a diagnosis of an Axis II Personality disorder or mental retardation? I am not advocating that we all need to get angry, the opposite is true actually. Instead of feeding the growing animosity in this world my hope is that we as professionals start an honesty campaign, that is to say, that we promote reason, balance, honesty and a sense of decency. Fight anger and hypocrisy with compassion and honesty. And please, do not mistake your anger for the insurance industry with anger towards the representatives that we work with on a daily basis to get authorizations, continued care etc. Like us, they are just cogs in the machine and doing their jobs. They cannot change the policy nor do they make it. In a future blog I will be discussing ways to increase positive outcomes when working with managed care. We are all in this together; imagine what we could do if we put people over profits? Not for profit -Doc Warren
Warren Corson III (Doc Warren) is a counselor and the clinical & executive director of a community counseling agency in central CT (www.docwarren.org).