Obamacare Is Care In Name Only For The Mentally Ill
I have healthcare; I just can no longer afford to use it for anything more than a doctor visit and a "please don't diagnose me with anything that requires more than, oh, stretching at home."
This story below -- of a housekeeper who started losing it mentally and then could find no psychiatrist to take her Obamacare -- is yet another story of...whoops!...how the "Affordable" Care Act is also the Affordable "Care" Act.
Dana Milbank writes in the WaPo:
One in five of us needs mental-health treatment at any given time, and for those who get good care, the recovery rate is between 60 percent and 80 percent -- higher than in many other medical fields. But only about 40 percent of the people who need treatment get any help, Santopietro said, and those who do "often get bounced around in a system that leaves them feeling misunderstood, stigmatized, brushed aside."Obamacare aimed to improve this woeful system by requiring mental-health parity. But psychiatrists, many of whom stopped taking insurance because of the paltry reimbursements, have yet to rejoin the system. This leaves the public mental-health system (clinics that charge on a sliding scale) overloaded.
"What we had is a major expansion of coverage, at least on paper," said Mark Covall, president of the National Association of Psychiatric Health Systems, a group of 800 mental-health hospitals. But now, "you have insurance but you don't really have access to these services because these services aren't readily available."
Thankfully, a bipartisan group in Congress is trying to fix this. The "Helping Families in Mental Health Crisis Act," introduced by Rep. (and psychologist) Tim Murphy (R-Pa.) and Rep. (and psychiatric nurse) Eddie Bernice Johnson (D-Tex.), attempts, among other things, to reinforce community mental-health programs. It has 165 co-sponsors and has already cleared a commerce subcommittee. Similar legislation by Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.) attempts to expand the mental-health workforce.
This is what happens when you pass the law to find out what's in it and don't hold the theories behind it up to how people -- doctors -- actually act when you decrease the money they're paid and vastly increase the paperwork.
A policy is not treatment.
This was missed by everyone - every one - who thought they were getting something. The generated idea was that the individual was getting something - when the only model that works is a system that pays doctors, not you.
I am experiencing something covered by that sentence in bold right now. Covered for the last 23 years by my employer's policy arrangement, which now takes $141/week from me, I cannot be seen by anyone before January 19 for an ailment which appeared in August.
A public who trusts political leaders gets what they deserve - screwed - and I am properly indignant to be carried along in this rush to stupidity.
Again, here is the solution.
Screw those thieves in office whose purpose was not health, but control!
Radwaste at November 29, 2015 7:47 AM
I hated the article, frankly.
"I heroically saved an immigrant housekeeper btw Obamacare sucks"
Pre-Obamacare the situation would have been....exactly the same. Shocking. The trend for decades has been that psychiatrists have been moving away from the insurance model.
Obamacare hasn't made things worse or better for the mentally ill.
Ppen at November 29, 2015 8:39 AM
"Obamacare hasn't made things worse or better for the mentally ill."
Does that actually logically follow the turmoil and added expenses it created?
Radwaste at November 29, 2015 8:52 AM
You're assuming mental health services work like other branches of medicine.
Or that there is logic to how they're applied or what medication you receive.
Ppen at November 29, 2015 9:25 AM
Our mental health system is atrocious. 6+ month waits for a psychiatrist when you're in crisis, no beds at the mental hospitals, Meds handed out by GP's with no particular training in mental issues other than what the drug rep told them, and what mental hospitals there are are drastically understaffed and falling apart, for the most part.
The de-institutionalization push of the 60s (yet another shitty idea rammed through by progressives)left hundreds of thousands of mentally ill people with no where to go and no treatment. Awful.
momof4 at November 29, 2015 10:33 AM
that there is logic to how they're applied or what medication you receive.
Posted by: Ppen at November 29, 2015 9:25 AM
Sounds just like other branches of medicine. The best treatment for you always ends up being whatever ether you or your insurance company can afford and or/are willing to pay for....
Isab at November 29, 2015 11:09 AM
"The best treatment for you always ends up being whatever ether you or your insurance company can afford and or/are willing to pay for...."
Giving patients what they can afford or are willing to pay for sounds like a type of logic.
Mentally ill patients aren't given what they can afford. Cost usually isn't taken into consideration when a doctor is prescribing medication, in patient or out patient services. A doc will know your financial situation and still refuse to give you cheaper meds or alternative treatments.
Also the best treatment means what in psychiatry? At this stage psychiatry is nothing but a well educated guessing game and in my experience out of pocket psychiatrists are as good as those working for the county or on a sliding scale.
The newer drugs have not proven to be better than the dirt cheap previous drugs. There really hasn't been any progress in psychiatry as there has been in other fields, hence perhaps why there are fewer and fewer new psychiatrists.
So no I don't think it's fair to say you get what you pay for in psychiatry. I have paid $900 sessions and $0 sessions and they're about the same. $12 med was more effective than a $2000 one. Even if you don't have insurance (I do) a doc isn't really interested in giving you the $12 med first, even if you ask.
Ppen at November 29, 2015 12:26 PM
"Giving patients what they can afford or are willing to pay for sounds like a type of logic."
Really? Did you say this out loud?
We have ample evidence, repeated across all sorts of trade, that what a person is willing to pay for is truly tiny next to what they imagine they can get from "government". They willfully disregard the plain fact that benefits they get from "government" are paid for by their neighbors. "Other people" are rich and can afford anything.
I had no idea that the practice of taking something from others to satisfy yourself, even in the case of illness, was any sort of logic. If that's not what you meant, please elaborate.
Radwaste at November 29, 2015 2:26 PM
Well at least you were able to suspect it's not what I meant.
Ppen at November 29, 2015 2:52 PM
http://www.cato.org/blog/time-i-debated-obamacare-kathleen-sebelius
=== ===
[edited] A boy in Maryland died at age 12 because his mother was unable to find a dentist who would accept Medicaid. An infection began in an abscessed tooth, spread to Deamonte’s brain, and killed him. An $80 extraction would have prevented this. But Medicaid pays dentists so little that only one in six Maryland dentists accepts Medicaid. Deamonte’s mother and employees at a local non-profit called dozens of dentists to no avail.
Sebelius responded that Deamonte would have died with or without Medicaid, and besides there is no alternative because “I don’t know any dentists who take uninsured people at all.” This from the woman once charged with leading the nation’s health care system.
=== ===
I think the $80 is too low, possibly exaggerating the tragedy. The main point is Katherine Sibelius's response. Essentially "Medicaid is better than nothing".
Most voters are not seriously sick. A political party can harvest votes by advertising to the well that the sick are being treated. The Veteran's administration hospitals are another example. Medicaid suffers from the unreliable votes of the poor.
Andrew_M_Garland at November 29, 2015 3:23 PM
Rad,
Ppen is right. You get what you pay for only makes sense when there is a relationship between cost and quality. For most goods such a relationship exists (I know it is not perfect). But with mental health it really is a crapshoot. The diagnostic tools just aren't there.
So going with the cheapest doctor you can find is the rational answer. Which is what Ppen said.
Andrew,
If Sebelius doesn't know of any cash dentists then she just hasn't looked. The best dentist I've ever had is a cash only shop. For a cash dentist an adult tooth extraction should cost between $100 and $200. For a child it would be less. And most cash dentists are willing to work with you in severe hardship situations. You can put that extraction on layaway.
Ben at November 29, 2015 6:18 PM
"You get what you pay for only makes sense when there is a relationship between cost and quality."
This is not what was said (It IS a central point in the solution I linked to above.)
It was, "Giving patients what they can afford or are willing to pay for sounds like a type of logic."
Giving anyone something, especially that is not yours, deciding the amount by the affluence or willingness to pay of the recipient is not logic at all.
And it is certainly not aided by ANY system which includes thousands of intermediaries who have not only no role in treating you, but actively remove the ability of the system to treat you by sucking up what could be treatment dollars in administrative costs!
-----
The complaint is made about psychiatric care. I must point out that the majority of medications advertised for depression have serious disclaimers due to a tendency to bring on the symptom supposedly being treated. I wonder just how much idealism is present in the idea that precise diagnoses are even possible.
Radwaste at November 29, 2015 8:52 PM
Rad,
That is what Ppen was trying to say. What you took from the one line was not there either. Look at the next sentence. She is complaining that doctors don't take the patient's financial situation into account and instead prescribe the newest and most expensive (but not most effective) meds.
"Giving(prescribing) patients what they can afford or are willing to pay for sounds like a type of logic." Giving meant prescribing not giving from the government.
As for your second section, is it theoretically possible to make accurate diagnoses? I'll optimistically say yes. Maybe someday someone will come up with a device or methodology that works. But in practice today it's garbage.
My wife ended up in the mental health system for several years. She was diagnosed with bipolar, psychotic, ADD, and some other things I can't remember. Her real mental health 'issue', tomboy. But the school system tried to cure her resulting in a large number of problems due to the drugs they insisted she take. This is why many people really hate Adderall Amy. It is heavily over prescribed and has significant side effects. She had a number of amphetamine induced psychotic episodes. I have yet to find a psychologist who will admit she was incorrectly diagnosed. Even off the record. Today she is completely unmedicated and doing much better.
I'm not pushing people to get off their meds or claiming mental health issues don't exist. I'm just pointing out mental health diagnostics are terrible.
Incidentally Amy, I can't take your word that Adderall helps you. Unsurprisingly mind altering drugs alter your mind. So I can't trust your observation of the situation. I also can't say you are wrong. I certainly can't diagnose you through the internet. But I would believe Greg.
Ben at November 30, 2015 8:23 AM
It's sometimes said the mentally ill may not get the treatment they need. True. But it's also said of those who get the most applicable treatment available and don't recover. The implication is that "mental health treatment" has a default position of 100% effectiveness. Therefore, if you don't recover, you didn't get the treatment you needed. Which is true, but kind of irrelevant.
Richard Aubrey at November 30, 2015 4:22 PM
Leave a comment