Volume 16 - Number 3 - December 2009
Pages: 220 - 331
Turken, H. (2009). The debate will go on: Health reform and the political system. Clio’s Psyche, 16(3), 258-260.
The Debate Will Go On: Health Reform and the Political System
Abstract
In this article, the author sets out a concern about the American health care reform debate and the forces that resisted change. The author attributes public resistance to defensive strategies formed in early development and settled by young adulthood, which the author says make people reluctant to depart from the familiar. The author also points to political forces that oppose reform on the ground that it would harm the economy and, through it, individuals. The author contends that deregulation and the introduction of managed care widened a disparity between insurers’ profits and the position of physicians and consumers, both of whom the author describes as instruments of the insurance companies. Three brief cases illustrate the author’s view of the system’s effects on ordinary people: rejected insurance claims and deductible and co-pay costs, a gap in Medicare prescription coverage, and long-term work without medical benefits. The author reports that polls show a majority of Americans favoring serious reform, yet expects only a diluted outcome. The author is sharply critical of lobbying spending and campaign contributions from the pharmaceutical and insurance industries, contending that these, rather than individual fears, now drive opposition. The author concludes that the system is failing many Americans, especially the sick, the elderly, and the working poor, and rejects the view that it needs no repair.
adaptive defenses, American politics, American health care, health care reform, middle class America, pathological defenses, psychohistory, young adulthood
The fear of change is as old as the beginning of history. In early development, the human psyche spends a great deal of energy in maintaining a workable strategy in the environment we are given (adaptive and pathological defenses). Once these strategies are the preferred mode of operating, usually in young adulthood, we become resistant in various degrees to new ideas and changes that require too much deviation from the familiar. Rather than readjust and change, it is better to stick to what we know even if it is not to our satisfaction. This was much the case for middle class America as the debate began in regard to health reform.
Change in health care reform involves not only the psychological, but also political forces that oppose these changes on the basis that it is not good for the economy and therefore for the individual. There was a time in the practice of psychoanalysis and psychotherapy in which both private physicians and the insurance companies made sufficient profit. With the deregulation of business practices and the introduction of managed care, a disparity grew. Physicians and consumers became a regulated instrument of the insurance company and their unsanctioned freedom to profit by raising premiums and increasing deductibles. It has become crystal clear that the system is not working for the average consumers nor for the providers of services. Yet the debate goes on. Government lobbyists are spending more money today than ever to further the profits on Wall Street and for the pharma-
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ceutical and insurance companies by influencing government and creating panic at the expense of the average Joe and Jane.
Let me start with some examples. R. was referred to me one year ago. For him I have filled out insurance forms time and time again that have been rejected one after the other. It was not until last month that we finally learned that all the money due back to R. went to his deductible; a deductible that was computed not on the basis of my fee, but on the basis of the 50% covered. This means that in addition to the deductible, he has to pay the 50% co-pay.
M., a widow, decided to retire when Medicare became available to her. She has had a bout with cancer, asthma and presently has trouble metabolizing sugar. She made her calculations and felt she could manage. M. was doing fine for the first six months until she entered the “doughnut hole” (the coverage gap when payments ran out) so she had to assume the full cost of her medications. Since her resources have been depleted faster than expected, she is taking what she feels is her only option: selling her apartment, moving to a retirement community in Georgia away from her daughter, extended family and friends. She was not prepared for this disruption to her life.
For the past four years V. has been working in the international unit of one of the largest investment banks rescued by the bail-out. She was hired on a per diem basis with the as yet unfilled promise of a permanent position within a year. She has no medical insurance, no sick days, and no vacation. She has applied to other similar facilities but with no prospect of getting better terms.
According to the latest polls, a majority of Americans are now in favor of some serious health reform; yet what will come out of Washington is a watered-down version of real reform. The feeling among those who were from the begin-
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ning pushing for substantive reform is that we lost the chance and that more than ever, political campaign contributions from lobbyists to our government representatives is what drives the opposition. It seems that the required regulations in the pharmaceutical and insurance areas will not be forthcoming to the detriment of the people who need it most: the sick, the elderly, and the working poor.
As it stands now, it is no longer the individual fears that oppose health reform, but political power bought by big industry. I have often heard the expression by those who feel secure in what they have: “If it ain’t broken don’t fix it.” But for a substantial number of Americans, it is broken.
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How to cite this article
Turken, H. (2009). The debate will go on: Health reform and the political system. Clio’s Psyche, 16(3), 258-260.
