Which Presidential Candidate Do You Think Best Serves Psychiatry

[Faebinder]

http://www.reuters.com/article/vcCandidateFeed1/idUSN2363970720080224


Obama-Don't like the Employer mandated responsibility (see it says "ALL" employers). Some employers barely make ends meet and this will hurt small business owners. The economy right now is in a bad state, last thing you need to is to burden small business owners.

Clinton-Don't know what insurance companies are going to do for the "coverage for everyone". Will that lead to even more denied claims for cases that deserved payment from the insurance company?

Also, I'm not seeing either candidate put any mandates on personal responsibility. IMHO someone doing behaviors that will make them take more money out of the communal health fund needs to pay for those behaviors. I'm not a big fan of paying (with my tax or insurance money) for someone's 15th stay on the psyche unit for cocaine use when that guy has no intention of stopping his cocaine habit.

I have no sympathy for employers trying to make ends meet but not taking care of the health of their team. So you want to work the workers like dogs and when they get sick you wont pay for them to get treated. Bad business day, maybe your business sucks. Why is the health status of the community compromised for your business to thrive? Screw that. What's next? Let the small businesses get away with no taxes to make thrive? Either you think the health of the community is important or you think it's not.

As for personal responsibility, I think Whopper is asking for middle ground and OldPsychDoc immediately pointed out the other extreme. I think we should all agree that some personal responsibility should be assigned to the patient. Some criterias should be set up. Admitted to the psych ward for the 5th time this year, why? cause you wanted your oxycontin fix despite rehab or are your antipsychotics not working on you again?

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[Therapist4Chnge]

As for personal responsibility, I think Whopper is asking for middle ground and OldPsychDoc immediately pointed out the other extreme. I think we should all agree that some personal responsibility should be assigned to the patient. Some criterias should be set up. Admitted to the psych ward for the 5th time this year, why? cause you wanted your oxycontin fix despite rehab or are your antipsychotics not working on you again?

I'd love for this to happen, but I'm not sure how to make it work in practical terms. The current system is pretty broken right now, but both of their plans are going to just make it broken in another way.

I hope neither gets their way....though I think that will be akin to trying to spit into the ocean.

*edit*

I just realized I have seen a few small scale attempts, that worked....at least somewhat. Giving breaks on premiums for people who quit smoking, went to the gym, etc. I'm not sure if that can be widespread, but I hope it can.

 

[OldPsychDoc]

I have no sympathy for employers trying to make ends meet but not taking care of the health of their team. So you want to work the workers like dogs and when they get sick you wont pay for them to get treated. Bad business day, maybe your business sucks. Why is the health status of the community compromised for your business to thrive? Screw that. What's next? Let the small businesses get away with no taxes to make thrive? Either you think the health of the community is important or you think it's not.

As for personal responsibility, I think Whopper is asking for middle ground and OldPsychDoc immediately pointed out the other extreme. I think we should all agree that some personal responsibility should be assigned to the patient. Some criterias should be set up. Admitted to the psych ward for the 5th time this year, why? cause you wanted your oxycontin fix despite rehab or are your antipsychotics not working on you again?

Why is it the employer's responsibility to manage the health status of the community? Either it is a personal responsibility, or it is the community's responsibility. If the former, then let's do away with shared risk entirely--eat your cheeseburgers and pay for your own bypass. Kid has CF? Tough break--buy them a full court press if you can afford it, otherwise take them home, make them comfortable and enjoy them while they last.
On the other hand, if it is a community issue, then why not share the costs more broadly? Let's pay in taxes what it costs to have a decent standard of health care for everyone. Let's work in incentives for people to take care of themselves and for providers to provide quality evidence-based care--because it is a community issue--like caring for the environment, for example. Let's put administrators and case mangers to work on those high utilizers getting their fifth rehab this year and figure out what's not working, and empower the providers as agents of the community to say "enough's enough--we don't have to admit you for this anymore." I'm not saying that universal coverage needs to make everything free for everyone, but that we take a wider, more socially responsible view of the benefits and costs of providing adequate care for the community.

 

[Faebinder]

Why is it the employer's responsibility to manage the health status of the community? Either it is a personal responsibility, or it is the community's responsibility. If the former, then let's do away with shared risk entirely--eat your cheeseburgers and pay for your own bypass. Kid has CF? Tough break--buy them a full court press if you can afford it, otherwise take them home, make them comfortable and enjoy them while they last.
On the other hand, if it is a community issue, then why not share the costs more broadly? Let's pay in taxes what it costs to have a decent standard of health care for everyone. Let's work in incentives for people to take care of themselves and for providers to provide quality evidence-based care--because it is a community issue--like caring for the environment, for example. Let's put administrators and case mangers to work on those high utilizers getting their fifth rehab this year and figure out what's not working, and empower the providers as agents of the community to say "enough's enough--we don't have to admit you for this anymore." I'm not saying that universal coverage needs to make everything free for everyone, but that we take a wider, more socially responsible view of the benefits and costs of providing adequate care for the community.

In the current system, some responsibility should be assigned to the employer. You can't claim that work has no effects on health. Cardiac, Coronary, Mental Health, and Pulmonary are all affected by the occupation. The entire specialty of occupational medicine is about all this. So if the employer is going to damage the worker when they work and reap the benefits why shouldn't the employer contribute? Use em and dump em when they are tired/sick is an old mentality back in the days before unions. Now if you switch to Universal health care, then yeah you shouldn't expect businesses to pay anything extra that they are not already paying through taxes.

 

[whopper]

I have no sympathy for employers trying to make ends meet but not taking care of the health of their team. So you want to work the workers like dogs and when they get sick you wont pay for them to get treated.

Would you want mom & pop businesses that CAN'T AFFORD to pay for health care to pay it or be forced out of business?

For example, the typical mom & pop pizza place is not raking in the cash. Its making enough for the owners to make a perhaps a middle class salary, possibly lower middle class. What if this pizza place can't afford to pay for health insurance for its employees, but is making enough to survive & keep its owners & employees happy.

Should this pizza place be put out of business by the government?

That's why I'm under the impression that forcing ALL EMPLOYERS to pay for their employees will hurt small business but aid big business. Several small business can't afford to pay for their employees health care. Another factor is the bigger the community pool, the more efficient & less costs an employer has to pay per worker--> in effect bigger companies have more of an advantage.

Having business tied to their employees health can bring up a conflict of interest in terms of patient privacy & care.

I do agree that business has some responsibility. For example, there are several studies showing that employers giving incentives for workers to keep in good health do have significant effects. The workplace needs to be a safe environment that will not cause future ailments. However flexibility is also needed for business to allow them to prosper & control their own affairs. My own opinion is employers can, perhaps should give health care to their employees but it should not be forced upon all employers. Also tax incentives should be given to employers to do business wide incentives for health.