Single Payer: No Way In Hell
by Dr. John Riolo
Listening to psychotherapists can be confusing at times. And that’s even when they are not using psychobabble jargon. Health care is an example. Almost universally psychotherapists want universal health care that will cover mental health conditions on parity with medical problems. At the same time many psychotherapists are striving to build “fee-for service” practices that have consumers paying cash for their therapy. They reason that they can charge more and that it’s actually better for the patients. I’m not sure I understand how paying more for the same thing provided by the same therapist is actually better but then we might be into a level of psychobabble beyond my comprehension.
Let me be clear. I am 100% in favor of universal health care. However universal heath care is not one and the same as a government run or operated single payer system. If we think we have problems with managed care today denying care or refusing to cover what we would consider necessary, imagine what it would be like having one and only one giant bureaucracy controlling all health care including what is covered, who will provide care and how much will be paid for it.
But they have a single payer plan in England, Europe, Canada and Australia. Perhaps, but they are having a difficult time keeping such systems afloat in other countries, so why should we adopt something that is failing? From what I hear from my Australian friends they are moving ever more closely to our system of multiple insurers for good or ill.
My friends from Canada are constantly praising their wonderful system. Well, look, I don’t want to say anything unkind about my good neighbors to the north. They have given us many good things including hockey, Bugaboo Steak Houses, William Shatner, cheap drugs and beer. That’s not bad at all. However their health care system will never fly down here in the USA. Why?
Well, for one thing Canadians themselves don’t help sell their system very well. Okay it’s true that many of us in the states sneak across the border to get cheap drugs in Canada. But when Canadians are coming south in herds as numerous as caribou to the US to get treatment because they have to wait a long, sometimes a dangerously long time, to get it in Canada, their system does not sell well.
It should come as little surprise that while Americans share many wonderful common traits with our Canadian neighbors, we are not the same. One thing that makes us different is that as a group we are not nearly as patient as our northern neighbors. We tend to want things when we want them, and waiting patiently in queues is not our strong point. Remember while Canadians patiently waited for the Crown of England to grant them independence we had a revolt that kicked the Red Coats and King George out. We are not good at patience.
In mental health that may tend to explain why we seem to be favoring evidence based short-term treatment models or medications over some of the older models ones where it took years to ever see a result.
However for me I think one of the biggest stumbling blocks of buying into a Canadian health care system comes from some of my friends and colleagues who are working here in the US as therapists but came from Canada originally. Don’t get me wrong, I am all for bi-directional immigration. But, I don’t understand why, if my colleagues find our health care system so primitive compared to their wonderful system, they are choosing to work here in the US as opposed to Canada. It is not as if we had a shortage of psychotherapists
John Riolo is a psychotherapist, Vice-President of Psychjourney and consumer advocate. He is known as the Insider and sometimes known as the therapist other therapists love to hate. His website Your Advocate Online includes many articles and audio interviews addressing the inner trade secrets of psychotherapy. Listen to his new Internet radio show, The Insider. Contact him at johnr@psychjourney.com