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Psychologist here. The arguments you're making could really be applied to healthcare in general. Others have pointed out the comparisons to insulin, etc. I thi

Psychologist here. The arguments you're making could really be applied to healthcare in general. Others have pointed out the comparisons to insulin, etc. I think you've basically made an argument for single-payer government healthcare. However, it's really not true that the typical mental healthcare user is a chronic user. The modal number of visits per outpatient therapy client/patient is 1. Many people feel better after one visit, or decide they don't need it, or it's not worth it (some of it is probably related to availability too, to be fair--they'd like to come more but can't afford it or can't get into the therapist's schedule). You can extrapolate outward from that. Many people come for a few sessions, and then stop without any explanation because they're feeling better but don't want to have an awkward conversation about stopping. The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US. My sense is the pendulum has swung too far in the shorter end of the spectrum, and a lot of people would benefit from more sessions, but even when they can afford it, are being cut off as soon as possible by therapists who are afraid of being seen as stringing people along. In some ways this is a good thing, but therapy length should really be dictated by need (short or long).

conanbatt 7y ago
> The arguments you're making could really be applied to healthcare in general. For many areas sure. Most importantly to primary care. I believe primary care should not be part of an insurance model. It's been brought to this for some good reasons and some bad reasons. Single-payer cannot fix over-utilization. The iron triangle of healthcare: cost, quality, access. If access is unlimited, cost will go up. (Over-utilization a term commonly understood for the use of resources for very low marginal returns). > The modal number of visits per outpatient therapy client/patient is 1 Even more sensical to make it cash pay! I would agree that cash pay in the current system probably leads to underutilization. Which is why a low(access x quality) x low(price) solution from the state would be great to help the bottom ranks and the rest can pay for it themselves. > The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US This brings another argument on utilization: if you look at it across cultures, it's going to be radically different. It's not something reasonable to insure against. Long term, freeing therapy from insurance works in the favor of therapists: as a political body I would ask tax exemptions that match what insurance companies get and be on your own. (I would recommend the same strategy to primary care doctors, and they are already doing it with the DPC model).

conanbatt 7y ago

> The arguments you're making could really be applied to healthcare in general. For many areas sure. Most importantly to primary care. I believe primary care should not be part of an insurance model. It's been brought to this for some good reasons and some bad reasons. Single-payer cannot fix over-utilization. The iron triangle of healthcare: cost, quality, access. If access is unlimited, cost will go up. (Over-utilization a term commonly understood for the use of resources for very low marginal returns). > The modal number of visits per outpatient therapy client/patient is 1 Even more sensical to make it cash pay! I would agree that cash pay in the current system probably leads to underutilization. Which is why a low(access x quality) x low(price) solution from the state would be great to help the bottom ranks and the rest can pay for it themselves. > The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US This brings another argument on utilization: if you look at it across cultures, it's going to be radically different. It's not something reasonable to insure against. Long term, freeing therapy from insurance works in the favor of therapists: as a political body I would ask tax exemptions that match what insurance companies get and be on your own. (I would recommend the same strategy to primary care doctors, and they are already doing it with the DPC model).