I agree completely that this is a multifaceted problem. I agree that access to care is very important. Access to care for severe and very damaging conditions is more important, from a policy and resource viewpoint, than access to care for ordinary counseling. Honesty is important. Its importance from a philosophical viewpoint is high, and its importance from clinical efficacy and professional ethics viewpoints is arguably even higher. Its importance from a legal/criminal viewpoint is often even higher (and of course overlaps with the others). As you said, the insurance companies are in a business. That business is not the provision of health/mental health services, but that of making a profit by offering financing for them. I think it is crucial to remember that (speaking broadly) nothing the insurance companies do actually prevents people from getting counseling. An insurance contract may keep someone from being paid or reimbursed by the company, but the decision to offer private services and accept a particular fee is the professional's, and the decision to pay for private services is the patient's. I understand that many people cannot afford, or do not choose to attach priority to, counseling services unless they are paid for by someone else, but that's true of lots of things (including shoes, gasoline, and television sets -- to say nothing of cable). Don't get me wrong. I very much dislike many of the payment plans currently being used. But much of my dislike for them stems from the way employers or large enrollment groups (including public sector contractors such as Medicaid programs and state mental health agencies) use them to shape payment plans for thousands of people, sometimes misleading them about what will be covered and what they are likely to need in the future. Put another way, in my somewhat conservative frame of mind, third-party payers such as insurance companies are offering something they don't _have_ to offer. People (patients and clinicians alike) are free to try to work without them, but most of us choose to use them (and many have become dependent on them, as if there were some "right" to have someone else pay for one's care). Our culture has pretty much decided that certain things _should_ be available to everyone regardless of ability to pay. I don't think ordinary psychotherapy and counseling are part of that decision (and probably rightfully so). That brings me back to my "high'handed" position that one should not fake diagnoses or lie about services in order to get money from someone else, whether an individual or an insurance company.
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