Dental, Mental, Optical

[filkertom]

I needed to snarl this morning, on why "health care" is divided up into four classes, three of which are apparently much lesser than the others for no apparent reason. You can check it out on Daily Kos.

Comments

[mythochromos]

I don't see how to comment over there or I would.

"Mental health parity" was included in the health care reform act. As of this year, mental health services are covered by insurance on an equal basis. For me at least, this means psychologist and psychiatrist visits are still considered specialist visits with a higher copay but they can't limit the reasons I go to see those doctors. Previously, I could only get reimbursed for some codes when it came to the psychiatrist; medication adjustment was the big one, don't remember the full details. (My copays for my psych medications are also lower but I have a feeling that's a different animal.)

On another subject, please don't compare the level of torment one mentally ill person goes through to another. Just as people have different physical pain tolerances, different things cause different people to break and to do it to different degrees. There are also different ways to suffer, just as a toothache's different from a cramp. Having a form of bipolar disorder, for me, tends to hurt or numb me. When the insomnia messes with my sleep cycle, though, not being sure what memories happened in a dream is terrifying. On a bigger scale, lumping together the effects of all brain-centric illnesses is painting with a very wide brush.

Likewise, labeling Jared Loughner as undoubtedly mentally ill (which I assume he is, considering how out of touch with reality he seems to have been) and going no further does a disservice. There are people out there who believe that mentally ill equals potentially violent, when the vast majority of people who have mental illnesses are not a physical threat to anyone except perhaps themselves. Blurring the categories contributes to the fear born out of ignorance that keeps mental illness a second class form of illness - and that keeps the "mental" in front of the name. Who goes around talking about dental illness, or gastrointestinal illness?

...Hey, actually, there's a tactic for me next time one of the unsupportive coworkers gets sick. *shifty look* Just got moved to a new team so I hope not to get the opportunity, but if it does...

[sunfell.livejournal.com]

I've never understood that, either. Health is health, and the neglect of oral and mental health is appalling to the point of being criminal. I bought extra insurance to make sure I keep my teeth AND my eyes healthy.

[zellion.livejournal.com]

Well, a lot vision coverage still make you cover the expensive part of glasses - the frames. And every dental plan I have been on is different than medical in that there's a max they pay out per year for you rather than the other way around with a deductible you have to meet and *then* they pay.

And braces and dental implants etc aren't really covered on a lot of plans. Long story short, there's a lot less that can go wrong with my eyes or my teeth that my plan will cover so it's way cheaper. Whereas with my heathcare for all they know I could get hit by a meteor or get cancer

[zellion.livejournal.com]

My point was this - they factor it in as a totally different "risk pool". If we ever go to universal health coverage I expect the current system to change.

[smparadox.livejournal.com]

Don't - even here in Canada dental and optical are separate but unequal. OHIP doesn't cover any of either as far as I know.

[zellion.livejournal.com]

Well when I get that colony going on another planet I'll change it!

[jmthane.livejournal.com]

For some of us, the frames aren't the expensive part. I have progressive lens bifocals that also correct a heavy astigmatism. My lenses cost about three times as much as frames.

Yea

[capplor.livejournal.com]

and then you add in the UV protection and the anti-glare, and it's painful.

[zellion.livejournal.com]

And do you have any kind of vision insurance and if so does it cover those lenses?

[jmthane.livejournal.com]

No, and no. Alas. I average a new pair of glasses about every five years, because I can't afford them any more often.

[zellion.livejournal.com]

*nod*

I'm one of the priveliged few who works for a very large corporation and thus has access to what passes for good coverage in this country. Mental health is inclueded in my health plan, dental and vision plans are separate but also through the company. Heck VSP even paid to put the
"transition" coating and anti glare on my last pair of glasses.

[jenk]

I've been getting new lenses in existing frames for 5 years now. Do need strong frames - mine are Flexons, but generally I think metal frames are more sturdy.

[jmthane.livejournal.com]

Alas, even when I have strong frames - the frame breaking is usually what prods me to get new glasses.

[peachtales.livejournal.com]

It's ridiculous.
I am also fairly certain that, if medicine here were practiced differently, I wouldn't have felt like I was losing my mind across 3 years of feeling increasingly horribly and finally losing house and job, all because of a thyroid that wasn't working properly.

[zibblsnrt.livejournal.com]

I'm at least a little relieved that people are at least starting to discuss that sort of thing the last few years more often, for all three of the "other" categories.

I've always particularly worried about mental, thanks to the distressingly large herd of idiots who "don't believe in mental illness" or whatnot and manage to be a constant source of pressure for individuals, insurers and governments to refuse to do anything about it.

[stormgren.livejournal.com]

Don't forget that the same herd of idiots think that it's still the demons in your head, and a good dose of Jebus will get them out.

(Nevermind that it's the Jebus-flingers that probably put a lot of that mental illness in people's heads to begin with)

Mental health coverage, public or private is a travesty in this country, and one that I'd wish we'd fix sooner rather than later.

[zibblsnrt.livejournal.com]

Nah, the herd that thinks mental illness is possession or sinful is a subgroup of the greater herd of idiots. There are a whole lot of people who don't have the least clue about how mental health works, but who are oh so confident that it's all a sham.

[kengr]

Not a "shsam". But they *honestly* think that you can overcome depression or a host of other things just be trying harder.

The same goes for just about any other condition that isn't as obvious as broken bone or a major wound.

Near as I can figure it's a twisted form of things like the "Protestant work ethic" and the "bad things happen because people deserve it". All come from the same set of mistaken assumptions about how the world works.

[ldyerzsie.livejournal.com]

My father is a convert to antidepressants since the episode where they put him on them for depression--a series of health issues interferred with work and it made him depressed--and his bad back and shoulder got better. According to him it is nothing to be ashamed of if you "need a little boost."

And alchoholism and bipolar issues run on my mother's side of the family.

"Trying harder" doesn't always work. Sometimes you need a little extra help.

[stormgren.livejournal.com]

Indeed, I'd forgotten about the Scientologists.

I'll differ on the blaming of Jesus for this stuff

[capplor.livejournal.com]

Some years ago, on a forum for Baha'i parents (an aside for clarity -- this is Robin, the mainstream Protestant wife in a mixed marriage) someone blamed THAT faith for all their problems. To make a very long story short, it wasn't anything wrong with the religion, she just suffered from some very bad parenting, which included the way that their faith was explained to a child.

Yes, you'll hear more about this sort of thing from Christians, but two factors will explain the majority of such cases. 1).There are more (people claiming to be) Christians in this country than anything else 2). As a partial consequence of #1, it is easier for the more narrow minded in this group to believe that anybody not like themselves is wrong/evil.

[redaxe.livejournal.com]

I'll just repeat what I've said before: any system that is set up for companies to profit on individuals' health will inevitably lead to generally worse health and individual horror stories. Healthcare insurance is a business that needs to become supplementary to a base level of care guaranteed by the government; this is exactly what a government's for.

[darthparadox.livejournal.com]

Yes. The insurance industry is set up right now so that every dollar they have to spend on your care is a dollar off of their profit margin. The interests of the insurance companies are aligned directly against those of the public. No system with for-profit insurance companies can possibly function (and by "function" I basically mean "not screw over the public" - obviously it's functioning just fine for the companies!) without massive regulation.

[redaxe.livejournal.com]

s/regulation/regulation and enforcement.

Because there are plenty of cases in which there are already consumer protection regs on the books, but the agencies whose responsibility they are have either no teeth or are understaffed, or, mostly, both.

[kirylyn.livejournal.com]

as long as congresscritters do NOT have to utilize the same health care coverage us "peons" do, there will never been "universal" health care in the US

as long as they can take advantage of "more comprehensive" health care, they will never GET it as to why people are "whining" about lack of coverage.

then again, the richer only get richer while the rest of us die out. then they wonder why they no longer have hot and cold running maids and pool boys.

[qnofhrt.livejournal.com]

Excellent piece Tom. I agree that until Congress has to deal with the same nonsense the rest of us do, it ain't gonna change.

[jhayman.livejournal.com]

I suppose it might be reasoned this way. Long, long, long ago, physicians and surgeons separated themselves quite pointedly from dentists. So part of that is plain old turf wars. FWIW, we don't universal dental care here in the frozen north.

However, opthalmologists and psychiatrists are both medical doctors, as such they *should* be covered under a medical plan. They certainly are here. The docs are the gatekeepers.

Optometrists were edged out of public coverage a few years ago mostly at the behest of opthalmologists. Physiotherapists and chiropractors went at the same time. However the government wasn't totally stupid: anyone who is at high risk for vision loss (ie diabetes or seniors), is still covered.

A lot of private plans cover some of these, including dental, vision including glasses. And a lot don't. It's all about what the insurer has negotiated with the providers of care and whoever is paying for the insurance.

But you're absolutely right.

[kengr]

However the government wasn't totally stupid: anyone who is at high risk for vision loss (ie diabetes or seniors), is still covered.

I assume you are talking about Canada or the like, because that sure isn't the case here.

[jhayman.livejournal.com]

Yes, I"m Canadian. I didn't mention it because Tom knows that.

[kengr]

Even medical care gets weird. I've got a *massive* umbilical hernia (my belly button is an "outie" the size of a tangerine). This is an imminent danger to me. But since I'm on the Oregon Health Plan (due to low income it's all the health care I can get, and I had to get lucky in a "lottery" to get into the program) they can't do anything about it until it strangulates or otherwise goes from "needs to be fixed" to "must be fixed to save life".

Dental care doesn't cover *any* "preventative care. And doesn't cover fillings either. As a diabetic, that's *insane*.

Optical care doesn't cover glasses.

Haven't gotten around to looking into mental health care, because I need to find somebody that won't cost me a fortune in bus fare to get to, and that I can work with.

Oh yeah, changing doctor/therapist once you pick one (and you *have* to pick one to get an appointment) is supposedly a major deal (essentially "wait till next sign up period or get a note from God" if I'm reading the docs right).

That's another bit of total insanity.

I got *really* lucky on the doctor I got assigned more or less at random at the nearest county health clinic. She's nice and she *listens*.

ETA: The hernia showed up while I was still on private health care, but wasn't "big enough" to get fixed without paying for it myself. After a couple years with no coverage, it's a lot bigger, but not covered under the "public" plan. *sigh*

[zellion.livejournal.com]

no preventative dental is insane! Most commercial plans make it free because good preventative care prevents expensive problems. Argh!

[lemmozine.livejournal.com]

Thank you, Tom, for shouting the truth to two groups of people: those who already agree, and those who refuse to listen. And good luck trying to get the second group to pay attention.