Why Psychoanalysts should endorse/vote for Bernie Sanders
The psychoanalysts’ couch has gone out of favor for more short forms of
treatment. With the upcoming primaries in the Democratic Party in the U. S., it
is important to not only look at how each candidate's policies would affect the
health care industry, but the practice of psychoanalysts as a whole. This leads
us to the premise of this essay, which is that Medicare for All is beneficial
for psychoanalysis. A couple of questions arise that will be each answered in a
small section. For the voter unfamiliar with the field, the question is
whether psychoanalysis is effective. For the voter unfamiliar with how
insurance companies operate, the question is on what grounds insurance
companies cover short vs long-term treatments. And finally, for the non-Bernie
supporter, the question is how Medicare for All could be payed and how it would
affect psychoanalysis.
Is Psychoanalysis
effective? - The symptoms
Not only in popular
culture did the conversation shift from “who is your psychoanalyst?” to “what kind
of medication do you take or what’s your dose?” but it also occurred at the
clinic. The common misconceptions are that psychoanalysis cannot be falsified
and, thus, evidence-based treatments are preferred. Or that they can be tested,
but psychoanalysis is not as effective as other forms of treatment. Both misconceptions
can be addressed by a simple google search. For example, one meta-analysis found
that cognitive-behavioral therapy (CBT), pharmacotherapy, and psychodynamic
therapy are equally efficacious (1). In fact, Jonathan Shedler found that the
effect sizes of psychodynamic therapy were as large as “empirically supported
and evidence-based treatments” (2). But if psychodynamic therapy is as
effective as evidence-based treatments and there is no difference in outcome
between manualized and non-manualized treatments (3), why did psychoanalysis
fall out of favor?
Insurance companies’
coverage of treatments – The diagnosis
There is a joke about
the American mental health care system that goes “if you feel like you need
help, look for a therapist that is covered by your insurance. They won’t be. If
they are, check whether they have any appointment available. They won’t. If
they do, after a couple months of waiting, just pay the $300 co-payment.”
This points out that one
of the biggest limiting factors in receiving health treatments is the accessibility
of treatments. In the first four states of the Democratic presidential contest
so far, there has been a majority of support among voters that preferred to “replace
all private insurance with a single government plan for all Americans” (4). Why?
Voters are aware of several things. One of them is the lack of insurance coverage
for much needed treatment. For example, United Healthcare lost a case in March
2019 for being unreasonable and using overly restrictive guidelines that denied
coverage, including children, of residential and outpatient treatment from 2011
to 2017 (5).
The lack of coverage of
needed treatments is a big concern. Especially when considering that is harder
to get coverage for long-term treatments. The effectiveness of short-term psychodynamic
therapy was covered in the last section, but is important to examine the
effects of long-term therapy too. According to a study conducted in 2018, psychoanalytic
and cognitive-behavioral long-term therapy is more effective at treating
chronic depression (6). The decision of the United Healthcare lawsuit was
applauded by the American Psychoanalytic Association.
Is the problem
insurance companies/our current health care system? Absolutely. Not only during
this period was United Healthcare refusing to cover patients to save money, but,
according to another lawsuit the company was overbilling Medicare by hundreds
of millions of dollars a year, stopped a repayment plan on 2014 to meet Wallstreet’s
revenue expectations, and reported unhealthier patients to receive $3 billion
worth during 2010 to 2015 alone (7).
Medicare for all –
The treatment
Who gets the worst
part of the deal? The patient; the public. However, the biggest concern of
voters before jumping on board of the Medicare for All train revolves around
the price tage. Three common misconceptions are that we don’t know how much it
is going to be, that it is going to be too expensive, and that we won’t be able
to pay for it. Bernie’s plan to be able to pay for Medicare for All is
explicitly laid out on his website, which we will cover from directly (8).
At the beginning of the section, a study from Yale
University is cited that found that Bernie’s Medicare for All bill would save
over $450 billion in health care costs and prevent 68,000 unnecessary deaths
per year. Our current system will cost approximately $52 trillion over the next
ten years. According to the Yale study as well as others, Medicare for All
would save around $5 trillion. That is a projected cost of $52 trillion minus
the savings of $5 trillion equals $47 trillion total. Our current federal,
state and local government spending over the next ten years is projected to
total about $30 trillion. The revenue options Bernie has proposed total $17.5
Trillion. In other words, $30 trillion of total projected spending + $17.5
trillion of new proposals = $47.5 Trillion total needed to pay for Medicare for
All. Since 2016, Bernie has proposed a menu of financing options that would
more than pay for the Medicare for All legislation he has introduced according
to the Yale study. These options include:
- Creating a
4 percent income-based premium paid by employees, exempting the first $29,000
in income for a family of four.
In 2018, the typical
working family paid an average of $6,015 in premiums to private health
insurance companies. Under this option,
a typical family of four earning $60,000, would pay a 4 percent income-based
premium to fund Medicare for All on income above $29,000 – just $1,240 a year –
saving that family $4,775 a year.
Families of four making less than $29,000 a year would not pay this
premium.
(This would provide about
$4 trillion in revenue over 10 years.)
- Imposing a
7.5 percent income-based premium paid by employers, exempting the first $1
million in payroll to protect small businesses.
In 2018, employers
paid an average of $14,561 in private health insurance premiums for a worker
with a family of four. Under this option, employers would pay a 7.5 percent
payroll tax to help finance Medicare for All – just $4,500 – a savings of more
than $10,000 a year.
(This would provide over
$5.2 trillion in revenue over 10 years.)
- Eliminating
health tax expenditures, which would no longer be needed under Medicare for
All.
(This would provide about
$3 trillion in revenue over 10 years.)
- Raising
the top marginal income tax rate to 52% on income over $10 million.
(This would provide about
$700 billion in revenue over 10 years.)
- Replacing
the cap on the state and local tax deduction with an overall dollar cap of
$50,000 for a married couple on all itemized deductions.
(This would provide about
$400 billion in revenue over 10 years.)
- Taxing
capital gains at the same rates as income from wages and cracking down on
gaming through derivatives, like-kind exchanges, and the zero tax rate on
capital gains passed on through bequests.
(This would provide about
$2.5 trillion in revenue over 10 years.)
- Enacting
the For the 99.8% Act, which returns the estate tax exemption to the 2009 level
of $3.5 million, closes egregious loopholes, and increases rates progressively
including by adding a top tax rate of 77% on estate values in excess of $1
billion.
(This would provide
$336 billion in revenue over 10 years.)
- Enacting
corporate tax reform including restoring the top federal corporate income tax
rate to 35 percent.
(This would provide $3
trillion in revenue, of which $1 trillion would be used to help finance
Medicare for All and $2 trillion would be used for the Green New Deal.)
- Using $350
billion of the amount raised from the tax on extreme wealth to help finance
Medicare for All.
This means that not only
the Medicare for All bill makes long-term treatments such as psychoanalysis
more economically accessible, but its ease of access would impact a larger
portion of the population. The only thing left to do is for psychoanalysts to
endorse/vote for Bernie Sanders.
5.
https://www.modernhealthcare.com/law-regulation/united-loses-court-behavioral-health-coverage-rules
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