Picture a black and white TV scene from the fifties with a class of clean-cut girls and boys standing straight and strong, hands over hearts, singing with the post-war patriotic pride instilled in them by the culture of the times. See a rather slight girl sweetly, but boldly singing in a voice so true with eyes misting over because she is so in tune with the passion in the music and the meaning in the words. She’s wearing her "I like Ike" button because that’s the candidate of her mother’s choosing.
The little boy who sits behind her in this first grade class wears a button too, but it is for Stevenson. He’s small and swarthy and must be all wrong, she muses, then surmises he’s chosen the Stevenson button because his name is Steven. What vanity, she observes, in her six-year old way of understanding the concept. The purity and innocence of her mind and the natural sympathy of her heart is already being turned by the sentiments of her local culture, by those close around her.
It’s easy to see how the Hitler youth were swayed a little at a time away from what came natural to their own hearts—the love and loyalty to their own families and neighbors. The natural instinct for caring and compassion. The empathic response that hurts when another is hurting. How easy it is to turn a heart cold, to turn the eyes away from seeing the ugliness that has come too close for comfort.
I saw the film, "Sicko" yesterday 7-2-07. I went, thinking it would be another typical Michael Moore film, where the reporter advances paparazzi style upon his prominent prey, exposing the latter’s part in the perpetration of some seedy operation. He would catch him at his worst—coming out to pick up his morning newspaper in pajamas, no make-up, and stumbling a little with a hangover. His voice would be gritty, his mind foggy, but he’d soon realize he’d been bamboozled—you’d almost pity the poor guy, except you deeply despise his deeds.
Well, I have to say, the film really moved me. Michael Moore stayed pretty much in the background in the scenes of the movie while narrating it. He didn’t intrude on or embarrass in a big way more than one poor befuddled doctor working for an HMO. I mean, maybe I have just been a little emotional in the last few days, but the people he introduced into the film were presented in a very real and un-staged way, so that their emotional expressions were natural and unforgettable, causing me to tear up more than once. It wasn’t like some news stories where you feel offended by how reporters are taking advantage of a person at a time of great grief and loss for the sake of the ratings. These expressions just came across naturally, as they happened in the moment.
"My native country, thee,
Land of the noble free,
Thy name I love;
I love thy rocks and rills,
Thy woods and templed hills;
My heart with rapture thrills,
Like that above."
My native country—yes there was a time in that first grade class, and beyond, that my heart with rapture filled in singing that song and saying the "Pledge of Allegiance". (Boy, that kind of scares me—realizing how strong the fear of the enemy still lingered at that time for those in charge to pander such clear propaganda to the very young—not much different at all from the tactics of the enemy! And to recognize how powerfully it influenced me as a child, so open to molding and making.) Yes, I was proud to be an American—home of the brave and strong—the saviors of the world from a great darkness. Hitler was pretty scary looking and so were those kamikaze pilots! Our guys were the heroes. And so was the Red Cross—those medical teams who would go into harm’s way to tend to the wounded. Did you see the movie, "Pearl Harbor"?
We never heard stories about those veterans failing to receive or receiving poor medical care when they came home. I guess that didn’t start until the aftermath of Viet Nam. "Born on the Fourth of July", one of Tom Cruise’s early movies gave us a heart-breaking account of that scenario. And it wasn’t long after (sometime in the 70’s) when Nixon, as documented by Michael Moore in startling footage of White House tapes, sold out to Henry J. Kaiser and initiated our present system of corporate profiteering in health "care".
"Let music swell the breeze,
And ring from all the trees
Sweet freedom’s song;
Let mortal tongues awake;
Let all that breathe partake;
Let rocks their silence break,
The sound prolong."
Yeah, I guess I remained fairly idealistic about the workings of our country until Kennedy was shot and the Johnson years began. I was a senior in high school and had just been transplanted to south Louisiana where racist sentiment was so high, the kids in school were cheering when the announcement was made over the PA system—"Yah!" they screamed, "the [n-word] lovah’s dead!" I was horrified! I had fallen in love with Kennedy and his "New Fraun-tiea", inspiring (well, at least some of) the youth of our generation with exceptional visions about what we may accomplish as adults in the near future. It instilled me with the fortitude and determination to forge ahead in life with high hopes.
There was some revival of national pride for me during the days of the space race he initiated. My dad worked for Boeing at the Michoud plant in New Orleans, and I, for General Electric under NASA at the Mississippi Test Facility during the building and testing of the Saturn ("moon rocket") booster. During those years everyone received medical care—we made enough money to pay our doctor bills and buy medicine, and small premium insurance paid for any injuries or surgeries necessary. The indigent were treated at Charity Hospital in New Orleans, which was run by the Catholic Church. The nuns were nurses there.
When I had my first child in 1972, I was working for the State of Tennessee Human Resources as a social worker and my husband was in dental school. I made less than (or maybe just around) $500 per month and a very small amount of insurance was taken from my salary (and very little more was matched by the State). I had a difficult labor and the birth was by Caesarian. There were some complications following and my daughter and I had to remain in the hospital for a week (but that really wasn’t uncommon for a Caesarian birth at the time.) It was really nice that we had the insurance to help pay, but really and truly, the cost of the surgery, anesthesia, and hospital stay was reasonable enough that we could have paid for it with the salary I was making and some of my savings.
Even as late as 1978 when I had my second child, the insurance premiums we paid through my husband’s affiliation with the American Dental Association and those covered for me by my tuition in graduate school at a state university were small, relatively unremarkable, and still, the cost for another Caesarian section (required at that time because of the previous surgery) was reasonable for the general cost of living. I have often wondered in the last few years, WHAT HAPPENED!??
As a health care provider in private practice, myself, there came a time when the contracting of fees by managed care companies cut my income so low, that with the cost of health insurance going so high, I was unable to purchase coverage for myself (leading some to categorize me as "financially irresponsible"). And many of my patients could not afford insurance coverage either, nor could they pay me a livable fee amount for my services. I have to tell you, I felt (and still do feel) really caught in a Catch-22. If I care about my clients, and continue to see them when they can no longer pay full fee or their insurance runs out, then I go broke and can’t pay my bills (much less my insurance coverage).
If I continue to see clients and accept an unlivable contract fee from a managed "care" company, then I began to feel demeaned and discounted. My services, my skills and talents are not valued in the larger economy and I become marginalized as a professional, as a person, and as a woman (because many in my field are women) though most live in a two income home. I am a single woman (formerly single mother) who is still trying to make it as a solo practitioner of mental health services. And if I need some therapeutic support for dealing with these issues, I can’t afford the fees of my colleagues. (Good thing there’s still a willingness among us to care for each other!)
There’s no way this set-up can continue. It is becoming more and more difficult each day for any health care provider to remain in private practice and to provide care as they have been trained to do and as they feel ethically responsible to do (and required to do by their various professional state boards). Nor is there an alternative position of employment that provides reasonable pay and benefits and recognizes the professional level of experience acquired through many years of practice and continuing education. Most available clinical social work or therapist positions are entry level or administrative positions. Those who are already working in some capacity with the federal government are given preference for any of the higher level employment positions available there. And many of those require a transfer overseas.
Well I won’t go on about my own career issues here, because my intention is to address a more general readership. Suffice it to say that, while the cost of living has risen substantially in the last fifteen-twenty years including fees for physical health care—M.D.’s and dentists (who have large lobbying organizations), fees for mental health services were cut almost in half way back then and have remained that low, some even having been cut lower. Why? Because the managed care industry has bought up the insurance market of employees from major corporate employers and "carved out" the mental health management from the remaining insurance companies. This enables them to force small independent practitioners to accept their fees or be left out.
There are always new clinicians hungry for clients who are willing to accept reduced fees. And the scare tactics are intimidating to those in our field who are meek and lack the predatory instincts of the more aggressive opportunists in the business world. I’ve noticed there have been some entrepreneurial types more sophisticated in these "business" practices lately who have formed mental health groups and contracted with therapists newly licensed as clinicians to work for their group (which they’ve already set up with the various managed care companies—a veritable feat to accomplish). These groups are paying these new therapists about half the amount of the already reduced managed care contract fees and then requiring them to see double to triple the amount of clients the typical provider in private practice would attempt to see during a day or week—and they’re still requiring them to pay for their own liability insurance and do all their own billing and documentation! (Not to mention self-employment tax.) What a rip off!
And let me say, while many foes of universal health care and the "welfare mentality" rage about the sense of entitlement that those served in these systems seem to develop, that you haven’t see "nuthin" ‘til you listen to the entitled corporation person, health card in hand, show up in your office demanding their rights to access of services with minimal copay! And shunning you if you’re not in their "network" without much thought about what quality of service their network has bought them. Talk about cluelessly entitled—the corporation "man" today is a highly privileged citizen.
I have seen copays for these $200k-500k plus per year execs be as little as $7 or even $0 per session while their corporation’s managed care contractor is paying a provider as low as $50 per session in a market sector where the general acceptable fee is $120-150. And be aware, this generally acceptable fee is still comparatively lower than what other similarly trained professionals in other fields with the same level of responsibility and liability for their clients (such as lawyers) receive for an hourly rate.
And even though contracted to the managed care company and bound by its authorized number of approved sessions and its determination of medical necessity, the provider of mental health services retains liability for the clients care (or "un-care" as some of my colleagues began to call it), carries and pays for his own liability insurance, and must continue to meet with the standards of her professional board of ethics which are strictly enforced. And don’t get me started on the loopholes available for denying payment for services rendered!
Should I tell you about the time when I was forbidden to continue to see a client beyond authorization limits even if I did so for FREE?? It was their client, they claimed, and if I continued treatment, I would be dropped from their network and a suit would be filed against me. (For what, I was never quite sure—taking ethical responsibility for the treatment of my client, maybe?) I’ve often wondered, but been afraid to ask how much the corporations were paying these companies for managing their employees’ care. No doubt they are making a sizeable profit—just ask Michael Moore—he’s got the stats. (I think I must have blanked out on those figures during the movie—too much for me to stomach, I guess!).
Of course, that’s just one of my own little private horror stories, and it was, I admit, back during the early days of the "hostile" corporate take-over of mental health services (now called "behavioral health", because if they’re acting alright—showing up to work and getting it done—but not necessarily feeling or thinking alright, then they don’t need any services). Ah, that feels good to get off my chest! You know there are research studies substantiating that just the expression in writing or speaking of a person’s feelings reduces the amount of emotional distress or conflict she is experiencing according to visible brain activity in emotional centers as it is recorded by a neurological scan? So obviously, just talking to someone who can understand and empathize with your feelings can reduce your pain or stress significantly.
And this is what was so noticeable in the Michael Moore film "Sicko". Once the people he gathered up (who had not received the care they needed even as insured patients from the health care system here in America) were taken to a clinic (in Cuba—go figure!) where they received just the attention human decency would require, where they were told they would be helped and not to worry, assured there would be no unaffordable charges and no treatment withheld from them that they might need to get better, you could clearly see and palpably feel (through your own empathy with the person’s facial and postural changes) their feelings of relief in that moment of realization that someone was listening and someone cared—someone was going to help them! You saw them literally transform before your eyes—standing taller, breathing easier, becoming more well by the minute—chronic symptoms dropping off onto the hospital room floor like fleas.
Haven’t we learned enough yet in the ongoing practice of health care to know that stress kills? That people who are cared for, prayed for, acknowledged and validated get well quicker? (Yes, research supports this premise too!) Not only is that a primary principle in psychotherapy, most nurses have it number one on their list of treatment priorities. And truly, most M.D.’s learned that somewhere in their training before they got thrown into the rat wheel of stressful demands upon their physical and mental capacities for life and death decisions during thirty hour days. Yeah, what about the mental/emotional health of our physicians? Can they afford mental health care, I wonder? Or is it more like, do they have the time available to access these services?
And one more thing, for what it’s worth—we now have, for good or ill, a number of services being made available by alternative health care practitioners, most of whom are not covered by insurance (though most think they’d like to be). Many of these practitioners have no education or training beyond what it took to be proficient in their particular skill area, and some have no training at all, but were just "given" an ability to heal, and yet they purport to do the same or better treatment of physical and mental/emotional disorders than licensed professionals. Their fees or "contributions" most often run higher on an hourly basis than those contract fees in my profession, and the service is being provided by a practitioner who is not licensed, regulated, or ethically supervised by any state board. And people pay for these services without question.
Why? Well maybe because being outside the system, these practitioners are able to employ the instinctive human capacity for compassion and understanding—for caring and praying over their clients, for providing healing touch, soothing the raging beast inside howling out for loving care. They haven’t yet been demoralized by the system in place and so are not sandwiched into the squeeze, the Catch-22 experienced by the rest of us. More power to ‘em! But it’s not going to last long. Already insurance companies are sniffing out their territory for future profits and have targeted these "complementary" or "integral" caregivers, for pulling them into the system. There is also a movement among licensed healthcare professionals pushing the states to require these holistic/metaphysical/spiritual-religious practitioners to be licensed and regulated. Soon they will be enveloped and controlled by the same system as the rest of us and falling prey to the same dis-ease.
Yes, my friends, now even God will come under the control and restriction of your healthcare for corporate profit plan! And remember, this managed system of "un-care" is a problem for everyone other than itself, the politicians they’ve bought, and the shareholders of these companies (that means you!) who are benefiting from this arrangement. It was stunning—and really downright sad—to see how clearly different the quality of care in Canada, Great Britain, France, and even in Cuba was from that here in America as I saw it painfully unfold in my viewing of "Sicko". I left the theater feeling like that little girl sweetly singing "my country ‘tis of thee" in a voice so true had just been molested. Sicko!
Happy Fourth of July, my fellow Americans...
"Our fathers’ God to thee,
Author of liberty,
To thee we sing;
Long may our land be bright
With freedom’s holy light;
Protect us by thy might,
Great God, our King."
