Monday, September 23, 2013

Awakening and Nightmares.

Those within the conservative blogosphere have written countless posts about Obamacare being a stepping stone to total government takeover of our health care. Canada has such a system where you cannot see your doctor outside of a government office. Those who can afford to pay for care, go to see doctors and get timely medical care within the United States.

I have a friend who is a psychiatrist in NYC and we have had discussions on government health care. She is a liberal, and proudly explained her support of Obamacare because - people have a right to medical care and our country has a responsibility to care for all those residing within its borders.  How to pay for something like this didn't concern her because from her perspective, she imagined herself and her elderly mother going to see any internist they wanted and not be concerned with payment.

She has a very different perspective on psychiatry, especially her practice. In NYC, most private psychiatrists do not accept any insurance, and people in need, pay them in cash. Overhead price for a psychiatric office is low as you only need 2 chairs and a desk, and typical charge is over 300 dollars for 45 minutes - that's a psychiatric hour. Hey, these folks are crazy after all.

It's fascinating to see a psychiatrist explain how it is therapeutic for patients to balance their bills, having to decide between paying their psychiatric bill and having to seek out a roommate because they cannot afford their rent.  It should not be surprising that a large portion of psychiatric patients are on medicaid and other forms of government assistance. These folks see psychiatrists and pay for their services in cash, but need lots of help from the rest of us to afford such service.

A very reasonable question might be: why don't psychiatrists just bill medicaid so that their patients aren't forced to chose between an hour of therapy and paying rent? The answer from most psychiatrists will be that in order for a patient to get the most benefit out of that therapy, they must commit to it in a real financial and physical way.  The answer from most others is - when a psychiatrist signs up with an insurance network, that psychiatrist must accept the rates paid by that insurance company. With medicaid, the money isn't worth the time investment.

So, my obamacare supporting friend wasn't bothered by the prospect of my having to accept government rates and because you see, I am the sort of doctor who should sacrifice for the sake of their patients because having your diabetes, pneumonia, and angina treated is a right. COPD she's not sure about, because she doesn't care for smokers much.

But now, a new aspect of the health care law is threatening her well being.  Now, medicaid is going to refuse to pay for medications, when these medications are prescribed by out of network doctors.  Psychiatric medications are expensive and while patients might have come to terms to pay for their hour of chit-chat, they will not accept paying for their medications out of pocket too.  Psychiatrist also know, that without the ability to prescribe medications, they are no more effective than a counselor.  At the same time, they cannot afford to accept medicaid rates.

She stands posed to lose over half her patient base and consequently may be forced to lose the business she has built up over the years. She didn't see it coming, because such things are never discussed among liberals.

The obvious reason for this legal maneuver is to push everyone into one government run health care group. Perhaps some psychiatrists will now wake up and no longer support this nightmare. On the other hand, perhaps they will stay asleep and teach themselves to cope with this nightmare instead; they are immersed in a world of crazy.  How else can you explain liberalism?

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