The Private Sector Doesn't Always Do It Better

In the ongoing national discussion of a plan for universal health care in the United States there are several factions.

One group insists that health care as presently provided by the private sector is the best and most effective in the world, and there needs to be no change in the system.

At the opposite pole are those (like me) who believe a single-payer plan, under which the federal government would assume the administration of a national health care plan, and would negotiate with private physicians and pharmaceutical companies regarding prices, would be the best, most efficent and most cost-effective way to go. Imagine the present medicare and medicaid programs expanded to include the whole population. Under these programs there is still generally freedom of choice for patients, who need only find a provider that accepts one or both of these programs, and most do.

A third option, which the Obama administration seems to be leaning toward, is a middle way, in which Americans would be required to purchase private health insurance subsidized, if necessary, by government funds.

Two weeks ago I wrote about mental health care "reform" in my state. In that post I maintained that when the state turned health care over to the private sector it substantially reduced the quality, availability and scope of services provided. I have included a link to the site of one of the private providers in my county. On the surface the publicity looks good.

You have to read between the lines. Mental health care "without walls" only means that they have no hospitals and no direct liason with community hospitals, and no other facilities for long or short-term stays. They have only the resources the "community" provides, which in practice turns out to be just friends and family. Patients in crisis receive short-term benefits, which means a social worker will talk to them and perhaps drive them to a doctor appointment or two for a short time, not on an ongoing basis. Patients deemed to be having an acute crisis may call and talk to a social worker, and perhaps be directed to needed assistance programs. This is called community support, and it is designed to be short term. There is a total of three social workers to assist hundreds of clients. Social workers cost money and don't really bring in the cash. Those with chronic or acute mental illness, especially those who live alone, are not served. They are not deemed sufficiently profitable.

The services of a psychiatrist, in my community, consists of one or two sessions speaking to a distant doctor via therapeutic teleconferencing. This allows the doctor to speak with a patient but not really observe their behavior, as only their faces and upper bodies appear on the screen. Follow-up care is thereafter provided by a much cheaper Physicians Assistant or nurse-practitioner. All of this in the service of profitability.

Group and/or individual psychotherapy are provided at intervals of two or three weeks or a month and only if the client has insurance. This works for those with moderate or mild symptoms but are not really enough for the acutely ill or those in crisis. Therapists are also few and work for smaller salaries and less benefits than they had in the state system. Again, the bucks don't justify the services.

When the mental health care facility was run by the state their first objective was to serve the patient and the community. While there was every attempt to run it cost-effectively that was not its raison d'etre. It has been replaced by those who serve the dollar, and they cherry-pick what services they will offer.

It's pleasant to think that the pursuit of financial gain is absolutely compatible with the best of human endeavor. But that hasn't happened for the mentally ill in our community.

A single-payer plan could potentially provide both quality health care and cost-effectiveness. Patients would still have freedom of choice among those providers which accepted their health care coverage. That's basically what happens in our present health-care system. Doctors, insurance companies and drug manufacturers would not, presumably, make such enormous profits as they would if all costs were paid for at top dollar, but it isn't that way now. Insurers bargain for the best rates from health care providers in the present system.

A single-payer plan would, hopefully, encourage quality care without rewarding pure greed.