(Editor's note: This column first appeared in the Citrus County Chronicle; its author has asked that it also be published in Health News Florida.)
One reliable indicator of health care quality in any nation is life expectancy. Unfortunately, life expectancy in the United States ranks in the bottom quartile of a list of 229 industrialized nations, according to the Organization for Economic Cooperation and Development.
Many of these same 29 nations also increased their investment in mental health services while, during the same period, the U.S. slashed its expenditures for psychiatric and mental health services.
Mentally ill patients have been dumped into our communities poorly prepared for them. Thousands of the mentally ill have joined the street people in many of our cities, and, reminiscent of Elizabethan England, the county jail has become the primary community facility for housing most mentally ill people in the United States.
Over 45 million U.S. citizens now lack any kind of health insurance, and millions more have very inadequate coverage in the policies they now carry. Among these with incomes below the federal poverty line, a third had no health insurance. Statistics show that among Americans who are inadequately insured, a significant number are sicker and die younger than those who have insurance.
It is no mystery why this is happening in this country. Because the insurance industry so thoroughly dominates our health care system, the basic concept, purpose and system of health insurance is defined by them. The U.S. subscribes to a business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money.
Under the business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit.
In most other developed countries, however, the aim of health insurance is simply to promote a social service for universal access to affordable health care for all citizens, and not to generate profits for stockholders, CEOs and other private business entities. The U.S. is the only advanced country in the world with a health care system based on avoiding sick people.
Mental health treatment services in general and talk therapy in particular have been negatively affected by insurance and drug company domination of the US health care system. Talk therapy includes psychotherapy, psychoanalysis, counseling, marriage therapy, family therapy, group therapy, psycho-educational groups, addiction treatment groups and programs, parent training groups, anger management programs and many others.
There are dozens of effective means to deal with human distress that involve talk between qualified professionals and people seeking help. Talk therapy is not one-size-fits-all. It is focused on emotional problems in relationship with oneself or others.
Insurers, with their focus on profit, seek to spend as little as possible on your mental health care. Talk therapy sessions have been drastically cut by insurers. Privacy has been invaded and is no longer assured. Your choice of therapist is no longer under your control.
Likewise, drug companies with profit motive want to sell you drugs. Drugs and insurance companies with profit motive want to sell you drugs. Drug and insurance companies often view talk therapy and qualified practitioners as a threat to their control over the health care system. These companies insist that mental health problems are due to “biological imbalances” which require only expensive medications.
A systematic campaign to discredit the value and competence of talk therapists exists when drug and insurance companies assert, for example, that most types of long-term therapies are not “evidence based.” Insurance coverage for talk therapy has in fact steeply declined since the mid-1980s, from 6 percent to 2 percent of all insurance payments. People seeking talk therapy increasingly must pay for those services out of pocket.
Many people with emotional and psychological problems make good progress with talk therapy or with a combination of talk therapy and medication. While drugs can indeed by helpful, they alone do not “cure” emotional distress and sometimes have uncomfortable side effects. Certainly, there are biological aspects to many emotional and psychological problems, but biology is not the only cause (or cure) for these conditions.
Consumers of health care services do not have to be intimidated into accepting inadequate mental health treatment. Citizens have a right to demand effective clinical service. Tell your health care plan that you want adequate access to qualified talk therapists if you have emotional, addiction or marriage and family problems. Let your employer or human resource department know that you want a solid mental health benefit that includes comprehensive talk therapy services.
We now have over two decades of experience with the conversion of mental health care into a business. Our health care is being rationed, its care guidelines determined by profitability and secrecy decided in private corporate boardrooms.
To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill. A 1997 study by the New England Journal of Medicine showed that a large number of Medicare HMOs engaged in favorable selection by “cherry picking” healthier individuals. Since 1987, the number of uninsured in the U.S. has grown by a million each year.
Our mental health care system needs to get private health insurance out of it. Little of value is offered by private insurance when 15 to 25 percent of the health care dollar is skimmed off for profit and overhead. If, for example, the existing Medicare program is now extended to all citizens (and not only to those 65 years and older) universal coverage or “Medicare for all,” for both mental and physical health is possible while strongly containing costs.
The transition to full enrollment in Medicare, for example, could be achieved by gradually dropping the eligibility age over five to ten years. Any losses in phasing out private health insurance industry jobs could be will offset by job gains in other American industries, especially since they would no longer by saddled with such high health insurance costs, as is now the case.
Medicare is much more efficient than private insurance, with overhead now less than 4 percent. More importantly, it cannot deny care to those who need it the most, and administration by a single-payer public entity makes controlling costs more possible.
Nobel Prize recipient Bernard Lown, M.D., of the Harvard School of Public Health sums it up nicely: “One may only hope that Winston Churchill’s quip will soon be realized: ‘You can always count on Americans to do the right thing, after they have tried everything else.’ The United States has tried any number of bad solutions for providing its people with health care. Long overdue is the recognition that medicine is a necessary social service that should be accessible to all citizens.”
F. Douglas Stephenson, LCSW, LMFT, BCD, is a graduate of The University of Chicago and was a faculty member in the Department of Psychiatry, University of Florida. He is a retired psychotherapist who practiced in Alachua and Citrus Counties.