We need reforms. Lots of them. But I just don't believe in the package that is likely to emerge...too many otehr viable options. Along with this sunshine idea, another occurred to me: what if each encounter with medical treatment required that the patient acknowledge and initial each procedure to be "performed"/billed? This is a model in many other commercial areas where complicated billing will emerge out of a contract or an episode. For example, a pt. is admitted to psych hosp. Pt, or someone acting in parens patriae, would initial to accept / acknowledge the bill-stuffing sleep-deprived EEG, and the faux, limited efficacy group therapy delivered twice a day by some psych tech assigned to the unit for the day, dressed up as "goals group," and "wrap-up group," and other such labels, which is little more than an excuse to charge yet another $150 (CPT code 90853 for those who want to add this to their menu of unseen charges).

In other words, you learn what goes on that will generate charges at your visit.

Pair this up with: shift the tax benefit FROM the employer pre-tax bnefit idea, to a consumer's tax-deduction expense. If you pay $12,000 for health ins., you keep documentation, report this in your form 10-40, and drop your taxable income by 12,000. Thus, roughly guesstimating a tax rate of 25%, you get $12,000 of health coverage for $9,000.

Now, individuals are shopping as informed consumers, and insurers will be marketing to them, instead of plying the benefits managers of large employers.

I think the right-wing talk show hosts have been confusing the race issue brought up by Jimmy Carter and others including the NYT's Maureen Dowd. Where Carter et al (and I) see the racism is the totally irrational opposition to Obama in general that posits him as "other." The Birthers and so on.

Just FYI, I"m on the psychology chat list over at LinkedIn, and there's quite a discussion going about the health care bills, the role of government in our lives, and so on. Including therapists weighing in on how insurance co's handle their services now vs. possibly in the future.

While I agree with what you're saying, MVT, there are all kinds of problems with a patient opting out of those useless goals groups. I found that out first hand. If a patient opts out of this, they're noncompliant with treatment and we all know what happens then.

When I told a nurse that I wasn't going to attend any more of the groups because I didn't have the finances to be paying to sit in a circle and listen to someone who is psychotic rant on and on, or pay to be asked questions like "if you were an animal in a circus..." she told me, too bad I would have to pay for it anyway. I did mention that it would be considered fraud if she put I attended a group and then charged my insurance company and myself for services never rendered. While that did shut her up, it lead to comments in my medical record like "noncompliant with treatment," "hostile toward staff," etc. It's a no win situation for the patient when it comes to psych treatment. You either do what they say in the pysch hospital or they will delay your release and write nasty comments in your medical record.

Lisa,
You need to come to NH for your next psych sojourn. Not attending "group" is Reason #3 for getting tossed out of the nuthouse. I was puzzled by this until I got my bill and saw that my insurance company paid $45 a pop (in 1983) for the DAILY worse-than-useless "therapy" group. Not attending "group" would get you tossed out of the place with lightening speed. They didn't care about compliance--it was all about the money, honey. They had plenty of customers to fill your bed so out you go, gotta keep these people in line so no excused absences whatsoever.

Hey, mvt, have you been to that place? You description of the faux group therapy really cracked me up.

My apologies, MVT, I misunderstood your post. After reading it again, I realize you do see problems with the opt in/opt out of treatment idea.

It is too bad, though, that the govt, insurance companies, and patients are being defrauded of so much money for the stuff that goes on in these psych facilities. My shrink agreed that the "goals groups" were worse than useless, but said the hospital has to have some way to keep patients occupied during the day. I guess it is a good way to bring in money, because they can pay the psych tech minimum wage, and bill the patient/government/insurance for "treatment." They sure don't like it when you don't go to those groups, and it's easy to see why.

Sherry, if I had known that, I would have requested an immediate transfer to NH. Lol.

I should clarify I was polite about my request to skip "group" at first. When my shrink came by, I explained to him my concerns over the financial burden that was going to fall on my parents, me, and the insurance company for something that was not helpful and was making me feel even more stigmatized. He was in full agreement when we spoke in private. My shrink even told me, they would have had to drag him kicking and screaming to attend those "groups." He told me it would have felt demeaning to him, too, but that I had to understand that it's just about keeping us busy during the day. I suggested a movie instead. So, when the staff kept badgering and threatening me after I had permission from my psychiatrist not to attend, I got pissed. (This was a different hospitalization than the one where they dragged me by my arms for not leaving the cafeteria in a timely fashion).

In retrospect, my shrink was a big part of the problem. He said he supported my decisions not to attend group in private, but he was telling the staff I was too "astute" to attend group. What a jerk.

Another way they would keep "voluntary" patients inpatient is the nurses told us if we left AMA, then our health insurance wouldn't cover any of our stay and we would get stuck with a big bill. So much for being voluntary.

I finally did get wise to this insurance stuff. During my final hospitalization I had already decided that if they didn't release me AMA or otherwise, I was going to call and cancel my insurance coverage.

My hope is that if this universal health care coverage thing passes that it won't make it more difficult for people to get out of the psych ward once they're there. Many times it was my insurance company's refusal to pay more days that led to my freedom.

I also hope that the laws regarding hospitalizing people against their will do not become more stringent. Many in the system manipulate the current laws enough as it is.