Taking Charge of our own Health

As a nation, we spend a LOT of money on health care. It’s expensive for a couple of reasons: the amazing discoveries, technologies and research which allow for astonishing cures and healing of human suffering is expensive to create. And secondly, because we Americans have treated health care not as a right, like public education, but as a service that we purchase, like energy or food.

Because of the early national decision to treat health care as a service, the pace and cost of advances in medicine has out-stripped most Americans’ ability to pay for it themselves. Hence, the explosion in the last century of our dependence on health insurance. We have become so dependent upon it as an addition to our pay, most of us have come to think of health care as something that our insurance pays for, as if it were an additional source of revenue to our family instead of a support to the health care we purchase.

This model leaves the poor, homeless and unemployed dependent upon our hospitals’ emergency system to receive the health care they need. And because treating normal health issues in the ER is like sending a battle ship to take you fishing, this solution is not much of one. But we are so wedded to the health care as a service model, the only solution that the best minds of our day can come up with is to provide universal health care coverage.

What makes me a bit crazy about this solution is the increased dependence we all have on insurance companies. And with this increase in dependence, comes a pressure to keep costs down as they add members who may use more insurance on average than others. So while more of us are covered, the coverage shrinks in response.

While this may be good for most Americans, it has not been good at all for mental health providers. We are the lowest paid health care providers as a group in the country, and reimbursements for our work are getting smaller and smaller each year. More of us are leaving our contracts with the large insurers, and some of us begin our private practices without signing contracts at all, focusing on serving the most people we can as Out-of-Network, or non-preferred professionals.

Mental health, one of the most important of the healing arts to learn and master, is slowly being pushed out of the health care arena. If you have tried to get an appointment with a local psychiatrist lately, you will know exactly this first hand. The recession has made this shortage worse, as the larger health systems cut back on mental health clinics and out-patient therapists.

While we continue to try to solve this growing crisis, we each need to consider how important our health is to us and act proactively. We need to stop expecting doctors to fix things after we have done willing damage to ourselves either by inactivity, abuse of alcohol, food, drugs or other things we ingest. We need to limit the excesses we have come to demand of medicine, whether that be for antibiotics, plastic surgery or that third or fourth expensive test. And we need to put our money where our personal priorities are, and be willing to pay a larger portion of our own care in our daily budget.

We have grown fat, literally and figuratively, at the table of insurers. We are bloated by the expectations that medicine, physical and mental health care are paid by someone else. If it is essential to our lives, we need to add it into our budgets, just like we do when we put gas in our cars and and food on our tables. Like it or not, we buy the things we need in our economy, and we must grow to understand that all this health care is not someone else’s bill, but our own.

“In insurance we trust” could be the motto of many Americans. As more of us receive coverage, more of our income will need to be set aside for health coverage. And that is as is should be, if only so long as we commonly consider health care a service we pay for, and for which we should have choices as consumers. 

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The Recession and Mental Health Care

The recession has kept people who need care out of therapy.

That was the consensus of a small group of private practice therapists I met with Monday. We are a interesting and somewhat diverse group of folks: three licensed psychologists, three LMFTs and a social worker. Each of us has an individual private practice in the southwest Twin Cities, and we meet every month or so in each others’ offices for support, case consultation and resource sharing.

As our meeting was coming to a close, one of us looked around and said, “I think people are coming to therapy less often, and when they do come, they are worse.” All of us agreed. We are seeing that in our new clients: more severe symptoms of anxiety and depression; people who need medication taking themselves off and showing up in therapy; couples who might have been helped out of their patterns two years ago, making appointments like a “Hail Mary” touchdown attempt and often not even showing up to their first session.

Stereotypes of psychotherapy, widespread in the American culture, already do enough to keep people away from getting the care they need. The same kind of fear of the unknown (people avoiding their annual mammograms or other preventative exams) keeps them from seeing therapists. People fear that therapy is all about dredging up past pain, and they would rather avoid it. Or they believe that they should be able to “get over it,” whatever it is, themselves. To be fair, therapy isn’t all about the past, but it takes long looks back in order to understand the present, so the stereotype is partially accurate. What isn’t true is that it’s a waste of time, or it never works, or that its a huge money drain.

That last part, about the money, is what we’ve noticed about this recession as providers. People have lost their jobs, or are afraid they will. That anxiety alone makes us more conservative, and hunker down, and save money, and stop doing anything new. The added anxiety about what may happen to health care and insurance in the current political debate stops even more people from reaching out.

One thing I know for certain, though: nothing matters if you feel like you are losing your mind. The mind you count on to talk to others, to do your job, to care for your children, to connect with your family and friends. Actually, good overall health is dependent on mental health. If you are so afraid you can’t leave your house, or so despondent you can’t get your kids off to school in the morning, it matters little if you have low cholesterol.

Psychotherapists live with the fact that we are the lowest paid professionals in our health care system. We struggle to overcome the giant obstacles to care placed in our way by costs and stereotypes, by stigma and shame. What we wish for is for people to seek help before they are desperate, before they decide to leave their spouses, before they think often about suicide, before they start to think that they can’t get any better. Life can be so much easier with good, quality care and a compassionate professional guiding you along.

If you need help, please reach out. And if you know someone who does, ask them to help themselves. Today.