Saturday, March 27, 2010

Health Care: Psych Doc Perspective

Okay, I have been called out by ER doc. Let me state my opinions from a slightly different perspective. I am for health care reform, but admittedly don't know if this is the right legislation or not. Let me give the reasons why I think it is good:

1) Something needed to be done. Let's not have tea parties because a president is trying to help people in his own country. The tea party people are the same ones who supported a "mission accomplished" president. Some mission. Some accomplishments.

2) People need insurance. The only ones who really don't have to worry about good insurance are the extremely rich (can afford any plan) and the extremely poor (get it through county/state/Medicaid). I suspect that most people compaining about reform don't actually pay for it or worry too much. Rather, they get it as part of their company benefits and think that it's easy to get. This is another group that has nothing to worry about, yet I think comprises most of the complainers out there.

3) My parents are in none of the categories listed above. Farmer/small business owner. Unable to afford employee coverage. Hell, couldn't afford coverage for our family except plans with $5000 yearly deductibles and strict lifetime caps. Deductibles met multiple times, e.g. ruptured appendix (brother), lumbar spine (me.) Hopefully these Americans can get a reasonable deal now.

4) Don't worry too much about shortage of physicians. Unless you're in primary care. The solution will be your friend the physician assistant. They can do the same work, but the government can pay them less. How do I know? Because every govt/private insurance plan pays psychologists to do therapy and won't pay psychiatrists to do it. Specialty physicians will be okay, except for those on the extreme end, like cardiothoracic surgeons, plastic surgeons, etc.

5) Psychiatrists in general don't have to worry much. Probably >50% are employed by some government agency anyway. The name of the health plan isn't going to affect much.

6) Another poster said that this would cause the smartest Americans to choose other fields because medicine isn't worth it financially. There may be some truth to that, but this will continue a trend going on for a while. Already, physician salaries a pretty much stuck and haven't been increasing in proportion to others. Medical schools were already lowering their standards way before this bill passed. Just ask me about the felons in my med school class.

Stay healthy. Stay sane. Either way, be happy you're not living in Sudan/Iraq/etc.
I'm proud to be an American, where I am a free man.

Yeah, I know, coming from a guy who often hospitalizes patients against their will.

-Psych Doc


Anonymous said...


I am with you.

Why is it considered Communist that everyone have access to basic, preventative health care?

Anonymous said...

You are ignorant and probably look like an insane retard. Who goes into psych unless they have an underlying mental problem.

DreamingTree said...

@Anon 8:51 -- Who posts an anonymous insult on a blog? If you were secure in your belief system, you would be able to formulate an intelligent response. Instead, you chose to insult Psych Doc's intelligence (rather immature) & career.

Good reasons, Psych Doc.

Anonymous said...

"3) My parents are in none of the categories listed above. Farmer/small business owner. Unable to afford employee coverage."

Thanks to this new health care law. You parents will now have to pay a penalty for not providing insurance for his employee. This law will also prevent insurance companies from denying coverage for pre-existing condition but the law did not put a cap on premium.

Yes Mrs. Jones we will cover your pre-existing conditions but premium will be $5,000.00 a month.

Hardly the solution we're hoping for..

Anonymous said...

Any thoughts on mental health parity laws? (That supposedly went into play in January of this year...) Even with GOOD insurance, mental health benefits tend to be truncated in my experience as a MH patient.

Chris said...

Anon, I suggest you read the bill because you're batting 1000 here. Small employers under 50 employees are all carrot and no stick under the bill that ended up passing, and while yes, general insurance isn't capped, insurances on the exchange program (the thing they did instead of a government option) would be capped at a certain percent of your income, depending on how much you make.

tracy said...

Thank you, Psych Doc.

BTW, i happen to think Psychiatrists are great!

Anon 2 You KNOW what you can do!

Bubba said...

Hannah, the implication of the new Mental Health and Substance Abuse parity law, remains to be seen. Again as previously mentioned employers with 50 or less employees are exempted from this law.

Also noteworthy is the fact that while the law mandates parity in plans that offer mental health and substance abuse services, it doesn’t require plans to offer those services. That's a slippery slope and again its total implication need to be seen.

What I am afraid of is that those plans that do effer these services might raise their rate and therefore employers have no choice but to increase employees contributions to the plan. In the end other employees end up paying for the care of their co-employees who have this medical problem.

I hope I am mistaken in my analysis but that's what usually happens when lawmakers passed unfunded laws. Regardless, we will all end up paying for it whether in the form of employee contribution or taxes, anyway.

Pink said...

"I'm proud to be an American, where I am a free man."

That is debatable, my friend. When you are being forced by the **Federal** government to buy a product or service simply because you breathe and walk, you are no longer free. (take notice of the absence of **state** government in my statement, please)

And please spare me the rhetoric about auto insurance (not forced to drive), home insurance (not forced to buy a home), life insurance (not forced to purchase...yet), or taxes (not forced to work..yet).

It's 'effin grand to be a "free American," isn't it?

DreamingTree said...

@Pink -- No one is entirely free to do as they please when the consequences affect other people. We all have rules/laws to follow. If people want to sign away their right to care if they can't pay, then I'd have no problem with them not buying health insurance. But, that's not what people want. They want to gamble with their health. I'm a healthy person, what do I have to lose? And then, when fate deals them a raw deal, they want everyone to have compassion & treatment that they can afford. I'm sorry, but people can't have their cake & eat it, too.

This applies to life in general. No one wants to pay taxes, but everyone wants the services that affect them the most. The only way to have true freedom is to find an isolated part of the world (does that exist anymore?) and live alone. Otherwise, we're all in this together.

Trust us....we're doctors said...

Wow, Pink. Be assured the sky is not falling. I will spare you the rhetoric of which you speak. Are you even sure what that phrase means, or are you just repeating what you heard from Ann Coulter or Rush Limbaugh?

Look. I am free to start a business, buy a home, go to school (for free!) and college, buy a car, live where I want, get a passport and travel. My list of things we can do is way longer than your list of things we can't.

Be glad that God or whatever you believe in allowed you to be born in or live in this country.

Because, Pink, you too are free. You are FREE to LEAVE if you don't like it.

-psych doc

Anonymous said...

ER Doc and psych doc are both ignorant and don't understand the economics behind the new health bill. Look at all the large companies who are having to write down their profits. They will soon reduce their benefits and force the government to foot the bill. Do you think they will add more workers? Is this good for the economy? You watch, the democrats will be voted out of office.

Anonymous said...

Are you and psych doc a couple? Maybe you are latent homosexuals?

Liz said...

Geez, leave the Tea Partiers alone. Liberals called for the assassination of George W., were known to throw a few bricks.....It's not hard to find these reports, you just have to have an open mind.

No one, nobody, is against folks having health care. The only thing we differ on is how to get there.

Liberals want a government tit to suck on, conservatives/independents want free market solutions and a smidgeon of personal responsibility.

My sister was watching with baited breath while Obama signed the bill into law; she was a bit dismayed to learn she would now be FORCED to purchase her own policy or face a 'fine'.....she doesn't earn much so she may qualify for Medicaid. Guess what? She's been on Medi-Cal her entire grown up life and is totally less than thrilled with this prospect.

Since all government entitlement programs end in bankruptcy, why oh why does anybody think it can pull this one off? It is wishful thinking at it's best.

Maybe folks just want to assuage a collective guilty conscience (best solved while acting locally, where some oversight can actually hold down fraud and waste).... ?


Bubba said...

There you go Liz, well said

Pink said...

I don't watch any news shows or listen to pundits. (Thank you for that oft-used talking point spewed everywhere).

Again, please expound on why exactly it is the responsibility of the **Federal** government to require a citizen to purchase a product or service. This is health *insurance* reform, not health *care* reform - two totally different beasts, are they not?

For the lay person, what if the Federal Government gave everyone a 100.00 gas card? What if every gas station near your home did not take that gas card and thus, you had to travel 100 miles to redeem said gas? How "worthy" is that 100.00 gas card?

R. May said...

I have to point this out because it's an issue thats driving me insane. The mandatory coverage that "liberals" are forcing upon us? Guess what folks that was the "conservatives" idea in the first place. That was what they proposed way back when Clinton was in office (how soon we forget) and check out Massachusets - conservative leader and mandatory coverage.

SO perhaps if we can all stop automatically taking the opposite side from what we perceive to be the enemy we could have intelligent discussion and debate and solutions.

Anyhoo I don't know that this bill is the solution. But I do appreciate that it's something. I'm all for trying. The world will not end because of this bill. Carry on.

Pink said...

@ R. May:

"The mandatory coverage that "liberals" are forcing upon us? Guess what folks that was the "conservatives" idea in the first place."

So, let me understand this. Clinton = conservative. How would you categorize our current President?

Secondly, here is a blurb from today's news about Mass', um, 'success' in healthcare reform -

"Governor Deval Patrick has made reining in runaway health care costs a centerpiece of his administration and his campaign for reelection — contending they are stifling the capacity of small businesses to create jobs. At the same time, health insurers argue that government is forcing them to sell policies at a loss that is unsustainable as the costs of medical services climb.

Filing the suit were Blue Cross and Blue Shield of Massachusetts, the state’s largest health insurer, and the five commercial members of the Massachusetts Association of Health Plans: Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan, Health New England, and Neighborhood Health Plan. All are nonprofit carriers."

R. May said...

Pink you need better reading comprehension skills. I never said Clinton was conservative because that would be an incorrect statement. When Clinton was in office and proposed health care reform the conservatives proposed mandating people have coverage as an alternative. The liberals screamed. Now the liberals did it and the conservatives are screaming.

Furthermore my point had nothing to do with success or failure of Massachusets program nor did I state it was one or the other. It has everything to do with if something is proposed by the opposite side it's automatically evil. There is no discourse, there is no discussion. There are insults and accusations. I do not expect my politicians to be gods, I do not expect them to have the right answer for everything the first time. I'm perfectly ok with trying things an changing them if they don't work. If you don't try you won't fail but you sure won't accomplish anything either. For the record I am not a Democrat and I am not a Rebulican. I am strictly unaffiliated because politicians in general irritate me.

halojones-fan said...

1) SOMETHING needs to be done, ANYTHING, RIGHT AWAY, get it DONE RIGHT NOW! Like giving a patient a few hundred cc's of epinephrine without verifying that they're actually having a cardiac arrest, DAMMIT MAN HE'S HAVING A HEART ATTACK AND WE HAVE TO DO SOMETHING NOW!!!

2) People need access to health care, which is not the same thing as "insurance". Every driver is legally required to have car insurance, and you know what? Car insurance doesn't cover jack shit.

Actually, car insurance is a pretty good model for where health insurance is going to wind up. Government-mandated purchase combined with government-mandated minimum standards of coverage, anything else--including basic necessities that will kill you if you don't do it--and even including minor injury threatments--will be paid for directly out of the user's pocket.

3) As people have pointed out, this bill "solves" the problem by basically letting your parents buy into Medicaid. And nobody takes Medicaid. Whoop-dee-shit.

4) "Specialty physicians will be okay, except for those on the extreme end, like cardiothoracic surgeons..." Yeah, fuck those chest-cutters man, anyone can do open-heart surgery! :rolleyes:

5) I like how you shit on rich people, claiming that they're against reform because healthcare costs don't personally affect them, and then you go on and say that you're okay with this reform because it won't personally affect you.

" happy you're not living in Sudan/Iraq/etc."

Oh, give me a fucking BREAK. Your argument is that we shouldn't complain that it sucks here because things suck worse elsewhere? By that line of reasoning we can't complain about anything at all, because we aren't being tortured to death, right?

Anonymous said...

I'm still amazed about the whole American medical system. (And haven't bothered to read properly up on it.)
I have no idea how we (in Norway) managed it, I'll admit that, but in the last year a three month psych evaluation, countless hours of therapy, an abortion, three different pills against tremors, one fill of anti-depressants that didn't work and contraception-shots have cost me far less than $1000.

I shudder to think of what it would have cost me in the US, I'm not made of money!

Kolly Flahua said...

Just curious as to what your thoughts are nowadays? Have they changed any since the original post? Thanks