Here's One Answer
Abstract
Here's One AnswerJack C. Schoenholtz, M.D. Mamaroneck, N.Y. As APA President Steven Sharfstein, M.D., wrote in his July 1 column,â Where Does the Money Come From and Where Does It Go?â:â [P]rivate insurance has cut back dramatically on paying for the treatment of our patients as the carveout behavioral health care companies have been successful in reducing costs (emphasis mine). More and more patients have become uninsured and/or qualified for care under public programs, especially Medicaid.â Health care coverage is not analogous to manufacturing. In manufacturing, there are only two ways to lower what are considered âcostsâ: increase production per unit time, while holding quality and expenses relatively constant (productivity, throughput) or controlling prices favorably by driving competitors out of (narrowing) the field, as with antitrust violations. What Dr. Sharfstein does not explain is that being in a purely cash-flow business, these companies have not reduced âcostsâ at all but successfully increased premium profits. Insurance manufactures nothing and, with the managed-care additive, stabilizes or increases premiums. His admission that âpeople with mental illness are at more risk than everâ concedes that there's no free lunch in medical economics. Since my good friend Dr. Sharfstein only indirectly answers the