Thursday, January 25, 2007

No Retreat

I've never written a post to respond to one of my own posts before, but I think this time I have to. I have gotten enough "Clink is a heartless bastard" comments that I need to write, for the last time, that my post on the Retreat was a criticism of the service, not the patients. It got warped into an animated and a bit of an angry discussion about who I thought was or was not deserving of treatment---as if I my opinion about that actually mattered.

It's no revelation to state that America has a three-tiered healthcare caste system: the have-nots, the have-somethings (with insurance) and the boutique set. I work with the have-nots. My patients are poor. I don't mean poor in a "don't-have-insurance" sort of way. I mean poor in a "My family died in a house fire because they were using candles for heat and light" kind of way. The kind of poor who come in psychotic from the streets after living over sidewalk grates in the wintertime. The kind of poor who will die fast unless they get locked up.

So when I see a web site like the Retreat it's like getting a punch right between the old values. It's a visceral reaction, an "" kind of feeling that can't even come close to comparing with what my patients will never have. It's a sense that the cosmic balance of justice has gone far far out of whack and that we are in for an upheaval of our own making if we don't do something proactive to address the problem.

I am not stating that the boutique patients are undeserving of care. I am saying that we as a society need to make sure that all who need healthcare receive it. We as a society need to make these decisions. They cannot be left to bureaucrats or businessmen, or even solely to doctors and patients. We have all created this system and we must resolve it. Boutique medicine is not the solution.

To do this we will have to answer difficult questions about where to put our resources and how far to go with them. We will have to weigh the pros and cons of a fifty minute therapy session for non-psychotic patients versus two med check appointments for psychotic folks. People who are receiving treatment now may have to give a little to make room for those who are receiving none. I don't think that's too much to ask.

[Addendum: While I was working on this post I read on CNN that all the current Democratic candidates are in favor of universal healthcare coverage. A national health system is on the way. Hopefully Shrink Rap's posts will help us prepare for this by leading some discussion.]


Dinah said...

I responded in my simultaneous post.

It's not the same pot of money, in fact, one might contend that The Retreat, which takes no insurance and is a self-pay cash on entry deal, makes money for Sheppard Pratt (the parent hospital) and thus subsidizes the regular psychiatric hospital. So those folks are paying for the care of those who can't. If you got rid of The Retreat, this would not increase resources for your patient/inmates, I think it only works that way in Communist countries.

I am in favor of Universal coverage, the current system of government coverage is unfair and actually rather random. But, as we have with education or any other resource (cars, houses, food), this will only happen in this country if there is the choice to either opt out or pay for more. A system like Canada which dictates that one can not go outside the system will not work here.

The next time we go out for a nice dinner, I expect you to bring the leftovers back to the prisoners.

ClinkShrink said...

Dinah that's exactly what I said in my original post---in one of the comments, anyway. The only redeeming quality (IMHO) about the retreat is that it underwrites care for many others who don't go there. I don't think that's the most efficient way to provide care for the poor though.

HP said...

I don't know anyone who complains about their medical treatment


Off topic but I just wanted to say I know plenty of Canadians who've complained about their health system. Things like having to wait at least 8 months for a brain MRI. When it works well, it's wonderful. When it doesn't, not so good. Similarly within the NHS in the UK (where I'm from). A relative recently had fabulous treatment for a very serious health problem but I know of others who have been stuck in the system waiting for ages.

I agree with Dinah. I use my private health cover in public hospitals. This provides direct financial benefit to the public hospital system.