Gratitude

The day after Thanksgiving, and I’m wrapped up in thoughts of gratitude. Start with my hosts, Jim and Carol Kane, and their other guest, Carolyn Bevan – a great group to be with, and especially ‘cause we were all willing to talk about our gratitude. I learned so much, especially the effects of survival and loss in the Vietnam War.

Next come my gratitude for my father and mother, and for the fact that I came along last, after my brother, Harvey – eleven years older – and my sister Thelma – eight years older. I know my parents struggled with the depression, but by the time I was aware, things had stabilized and I was spared the worry. My father was fortunate never to lose his job, though, as I understand it, he was paid in scrip for a while. I actually have a piece of that scrip in my “family” file. My father was a generous man, never concerned with accumulating money, but with using it wisely with unadvertised gifts to relatives and friends in need, and contributions to his church and other charities.

As I understand it, he would never have advanced as far as he did at the Bristol Brass if it had depended on him to argue for advancement. It was friends who threatened his bosses that my father might leave if he wasn’t recognized. He was valuable, and they promoted him.

I was the beneficiary of my parents’ belief in education, and their early feminism, when they paid my college expenses and my early years in graduate school. I might not have finished my Ph.D. after I was married if they had not subsidized me then. My appreciation for that also contributes to my annoyance when people who have been similarly fortunate claim that they have pulled themselves up by their own bootstraps and accuse others of being “lazy.”

My appreciation has to extend to the fact that I began my teaching career at a time when Southern Connecticut State University was hiring and paying. (It was Southern Connecticut State College at the time.) I was fortunate that I was promoted to Full Professor just before the state ran out of money and for years we had no new hires and few promotions.

I’m grateful, too, that, when I began my private practice later in my career, managed care had not yet taken over. And now I appreciate my father’s attitude toward money, which I hope I’ve inherited as I adapt to my small, outside-managed-care practice in Minnesota.

My parents chose to live in the not-so-grand suburb of Forestville rather than on the Hill in Bristol with the other “successful” businessmen. I assume it’s because the Gustafson and the Anderson families and Bethesda Lutheran Church were in Forestville. I’m glad they made that choice. All I had to do was cross over into an adjoining back yard to play with my friend Hallie. (Some people suspect our friendship was a model for Dara and Adah’s in “Mrs. Job.”) I’m grateful for the years we stayed connected, though apart, and I’m grateful now for the memories, and the fact that my daughter and I were there several years ago to help witness her move into the next stage of life’s journey – a peaceful move, thanks to Hospice.

I’m happy also that my cousin Eunice was nearby. I remember our playing pick-up sticks, going to Hammonasset State Park with Aunt Gerda and Uncle Everett, climbing in and out the driver’s side window of my father’s car, and being dressed in African clothing when the missionary came to speak. I’m happy I got to see her again in Bethlehem, Pennsylvania a few years ago before she moved on last year.

I guess I’d better stop for now, because the list could go on and on. Someday I’ll delve into all my friendships and mentors after Forestville.

Finally, though, I want to say how grateful I am to the folks who have read and studied “Mrs. Job,” and written reviews on amazon.com.

"HEALTH CARE" INSURANCE EXPERIENCE

I just can’t help myself. I need to talk about my experience as a practicing psychologist dealing with insurance companies. I want to make it clear that this is just a report of my personal recollections of my experience as a provider.

Back in 1978 I completed all requirements to become a licensed psychologist in Connecticut. (Incidentally, In Connecticut, at least at that time, one could use the title “psychologist” only with a PhD or PsyD and the license to practice.) I began my private practice while still working at Southern Connecticut State University. I confess it was hectic. That’s when I learned a few lessons about controlling the schedule of my own life. But when I retired from SCSU in 1986, I was able to devote my time to my practice, and there were weeks when I saw as many as 30 people. I think I helped some of them.

I guess you might say those were my glory days. I set my own time, my own fee schedule, and kept my own records in keeping with the ethical standards as I understood them. Most of my clients were able to pay me full fee at the time of the session, and I provided them with a statement at the end of each month, which they could submit to their insurance company. So bookkeeping was quite easy. And it gave me leeway to see some folks at reduced rates as needed.

Then came managed care. I had to register as a provider with appropriate insurance companies. I abided by their rules, in most cases allowing me to see clients for six sessions without permission. I had to provide the appropriate paper work, accept co-pays, and wait for the balance of my payment. Needless to say, the billing process became much more complicated. I also became aware of what was going on in the offices of the doctors I visited for my own needs. They were hiring more and more people to handle the paper work.

What bothered me most, however, was the process my client and I had to go through to get permission to extend payment beyond the original six sessions. It was a balancing act, really, convincing the reviewers that we were making sufficient progress that it was worth the insurance reimbursement and that my client was still “sick” enough that it was worth continuing to pay. My personal ethics didn’t allow me to talk about my clients behind their backs, so we would spend a session figuring out the most honest presentation that would allow continuation of their coverage – basically losing a session when we might be working on their own growth. (By the way, I confess that in providing completed insurance forms under any circumstances I was buying – with a sense of moral conflict --into the whole “illness” model when I really felt that the folks who came to me were the healthiest who were willing to work at improving their own lives.) I was never happy with the loss of confidentiality.

I confess the people I interacted with at the insurance companies were very pleasant. I think they approved of the way I worked. I do not recall that any of my requests was turned down. I was also pretty sure that the people I dealt with were not licensed psychologists with training and experience similar to mine. It seemed, rather, that they were working with a list of acceptable responses. It was probably an advantage for the economy that their jobs were available, and I honestly respect them as people seriously and ethically doing their jobs.

When I was myself a client things were handled in the old fashioned, pre managed care way. I never felt that someone other than my therapist and I was in the room, looking over our shoulders. But when I applied for disability insurance from – believe it or not a Lutheran organization – they wanted to charge me extra because I had been in therapy. That in spite of the fact that I had never missed a day of work in my college career. (That’s another story, because the college president had made it clear he didn’t like hiring married women with children, so I had to “prove” myself by never getting sick. Even my children chose to save their sickness for school vacation.) Fortunately, I was able to get disability insurance through a company affiliated with my professional organization. (And none of my retirement money went to the care of that Lutheran organization – stubborn Swede, I guess.)

To summarize, in my experience, when insurance companies took over managing health care, there were losses to confidentiality, choice, efficacy, and efficiency.

Then I personally got old enough to be covered by Medicare. I have never had any problem choosing my own physician, though I fear the day may come when Medicare fees to providers fall so low that some health care providers will give up supplying care to Medicare patients. That’s a wrinkle in our system that can be cured.

When I moved to Minnesota, where I am also licensed to provide psychological services, I refused to have anything to do with managed care, which means that I now see only the bravest who realize that they are not really limited to the provider list supplied by their insurance company. For me, it means that my profession has changed – more emphasis on writing, though I do so enjoy working with the wonderful folks who give me the chance to work with them.

Why am I writing this today? Because I heard another speech yesterday claiming that a new health care system would deprive us of the “freedom of choice” that we have under our current system, not recognizing that we are currently expensively constrained not by government, but by a monolithic system that grew around us as we hardly noticed what was happening.

I want to repeat, I’m writing from my own experience. I am not a political scientist, or economist, or politician. I just want to share what I personally have seen.

Oh for the good old days of Dr. Frost. They will never return. But I do hope we will reach the point where our debate is honest and informed.

I found Reid’s, “The Healing of American” very helpful, on several issues, but apropos to the current topic, on the issue of choice in other countries with broader health care service than ours.

I hope the blog system will let this link go through, because you might be interested in seeing the reviews of his book.

http://www.amazon.com/review/R16SZ49JA9D9NM/ref=cm_cr_pr_viewpnt#R16SZ49JA9D9NM

I’d welcome comments on this blog.