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The Continued Inability to Ethically Match Patients with Providers

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at July 26, 2016

In an article entitled: “Frustrated You Can’t Find A Therapist? They’re Frustrated, Too”, Kaiser Health News writes:

There are a lot of people suffering from a mental health condition who need therapy. And there are a lot of therapists who want to help them. But both sides believe the insurance companies that are supposed to bring them together are actually keeping them apart.

Insurance companies, for their part, say there’s a shortage of therapists.

But it’s not that simple. Especially in urban areas, there are lots of therapists. They just don’t want to work with the insurance companies.

According to one California therapist:

“One, because the reimbursement rates don’t provide a living wage… You can’t own a home and drive a car and survive on what in-network providers pay you.”

In response, Charles Bacchi, CEO of the California Association of Health Plans, a trade group for the insurance industry, states:

“I think it’s unrealistic to expect either the state of California taxpayers or for health plans to just pay providers whatever they ask to be paid…  So you’re either in the system, and you want to be part of our health care system. Or you want to do concierge service outside of it and just pretend our health care system doesn’t exist. That’s your choice as a provider. Our job is to find providers that are willing to be part of the solution and willing to provide coverage to those of low and moderate income.”

Our Takeaway: Providers are going to use the free market system to find patients/consumers. However, the same economic rules which apply to standard models do not apply to a faux system where the payor (insurance companies) are not the same as the consumer (the patient). It’s similar to your child taking a toy from your toy store and then the parent telling you how much they are willing to pay for it. This economic paradigm is irretrievably broken, to the extent we are going to match profit motive with a service industry.  While we make no comment on a single-payer model and its potential immediate impact on level of care (having to instantly evolve from a for-profit to a non-profit model), it would seem that the current model still needs significant work. Repealing the Affordable Care Act is not the answer. Continuing to tweak and rework the system is.

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