Success is irrelevant to the insurance industry because what matters is short term (quarterly) profit and loss, not people's health in the long-term or even long-term cost-savings. Take my patient Mary as an example. Mary was referred by a mutual friend to work with me to reduce pain and restore functioning. I worked with Mary for eight sessions and we started making progress toward reducing medication and reducing pain. Then Mary heard from her insurance company that they would not pay any more than 8 sessions. Because we were making progress, I offered to work with Mary for whatever she could afford, even if it was only $5 a session. She declined saying she only wanted to do what her insurance would cover.
Why do I see select patients for little or nothing? Because I need to feel effective. Within the constraints imposed by contemporary health insurance, rarely can I help people with chronic disease and suffering in a meaningful, transformative way. I have invented ways to circumvent this healing circles that are peer-led or relatively leaderless in which everyone helps everyone else and no fee is charged. It is the patients whom I see for next to nothing who are improving and reducing costs to the health care system. The ones insurance cover are not getting well very fast.
We should consider this in the health care
debate. Data is available for discussion. Numerous studies have shown
that 80% of primary care visits to health care practitioners involve the
ordinary suffering of daily life and not diseases that need treatment,
yet we throw pills and potions at these woes as if that is their
solution.
Health care reform will never work unless we find
cost-effective ways to address the ordinary woes of daily life and stop
attempting to medicate them away. This will not happen until insurance
coverage is expanded to include coverage of prevention and
non-pharmacological therapies. I would be thrilled if we moved toward a
system that rewards good outcomes.
If I were paid in accordance with people's getting better instead of compliance with a list of covered services, I would be much better off finacially and might find more effectiveness and sense of satisfaction from within insurance reimbursed services. That would be a novel experience I would welcome.
