STOCK MARKET WATCH -- Wednesday, 18 July 2012

[Demeter]

19. Reports from Health Care Practitioners

http://healthafteroil.wordpress.com/2012/07/16/reports-from-health-care-practitioners/

Health after Oil will occasionally offer reports from practitioners who are aware they are working in health systems that are unsustainable and in need of transformation. We begin this series with two practitioner accounts of reactions to the implementation of President Obama’s recently Supreme Court upheld health legislation. The first is by Dr. S., a psychotherapist in a rural setting. She discusses the possible implications of the Affordable Care Act (ACA). The second post is by Michael Bennett, a nurse, commenting on how the ACA has overlooked the issue of ecological sustainability. Dan Bednarz, Ed.

Obama’s Affordable Care Act as Prelude

By Dr. S.

As a solo mental health practitioner in a remote rural California community, I’d like to share my experience with what is happening along the way to the collapse of our health care system. I opened my private psychotherapy practice in this rugged and remote area of California in 2006 because it was a community where there were no locally based full-time practitioners. Residents who needed mental health care were either foregoing treatment or driving an hour each way for their 50-minute hour of talk therapy or their 10-minute “med check” with a psychiatrist.

I reasoned if I established mental health services here in this rural community when the health system/economy was still running, then as the collapse unfolded I would be able -in this localized setting- to offer my services in whatever alternative socioeconomic system of exchange emerges. While there is still no local psychiatrist here, over these past six years I have been able to establish a successful private practice. This has been made possible by 1) advertising in the local community newspaper, 2) working hard to get into as many insurance networks as possible so that people with insurance can see me and 3) offering a sliding fee scale for clients without insurance.

While I have always favored shifting health care to a single-payer system, I did not oppose President Obama’s Affordable Care Act (ACA). As this “reform” is beginning to take shape in California, however, I am seeing that it will most likely put me out of business and thus leave our rural community once again without access to local mental health services. This is not only an economic concern to me but personally and professionally frustrating because the localization of health services will be critical in the net available energy descending society we are now entering.

Today I want only to discuss why the ACA is working against my efforts to build a localized practice.

From what my clients and I are experiencing the actual implementation of ACA appears designed to channel or “incentivize” existing and newly insured clients into large bureaucratic urban-based profit-making HMO’s centered around primary care providers. This type of care occurs in clinic settings where fee-for-service payments to free-lance providers such as myself are eliminated. Instead the HMO gets a per-enrollee allotment and then covers provider salaries or fees to nearby providers in closed or limited networks. This would not necessarily eliminate private practitioners like myself from participating since, theoretically at least, we could negotiate agreements with the HMOs to accept whatever payment the clinics would offer. Even if this is possible, however, this is not the direction the HMO’s appear to be taking.

Instead, they seem to be moving toward hiring or contracting with select providers in highly populated areas, often using interns or newly graduated professionals –to whom they can offer low fees compared to more experienced and higher credentialed therapists. These interns and recent graduates are expected to use cookie-cutter, evidence-based, treatment protocols for as brief periods as possible. In other words, the profit of the HMO, not therapeutic efficacy, gives every appearance as being the primary goal....

AS A PREVIOUS PRESIDENT WOULD CROW: MISSION ACCOMPLISHED!