Please do this for me; even if you never contact me and ask for a consultation or supervision, just do the following.
- Print out this page.
- Cut out the title to this blog post.
- Find a picture of your child, partner, parent or other loved one.
- Tape the title to the picture.
- Place it on your office desk, where you can see it every day.
This week in MA, we had further seismic tremors in the land of health care. Two tremors in fact. First, the news broke that our three biggest insurers Blue Cross, Harvard Pilgrim, and Tufts had reported financial gains this past year and strong investment income. In addition, the story reported that the CEOs of these companies made salaries ranging from 780K to 1.2 million dollars. News also revealed that BCBSMA’s board members collected an average of $68,000 last year to attend board meetings. That’s roughly $1,100 an hour.
The other big insurance news was that Tufts and Harvard Pilgrim decided to call off their merger. The reasons cited were that there wouldn’t be enough savings to offset the cost. Translation: They just wouldn’t make enough money to make it worthwhile.
What does this have to do with anything? Lots.
First, the salaries and board stipends underscore that Blue Cross Blue Shield is a non-profit business. That is why if you look at this list of BCBSMA’s Board of Directors, you will see top-ranking business-people and government officials. Put simply this means that it can dispense its surplus to reward board members and top management. They are a franchise, and in many cases, publicly-traded companies.
Second, and this is a reiteration of the first in a lot of ways, health-insurance companies are designed to make money, not just break even. They are a Non-Profit not because they don’t make money, but because of the way they disburse the money made, to their managers and board members (who incidentally are some of the people who have legislative power when it comes to healthcare reform.)
Back to your picture and my post title.
You are not a non-profit. You don’t even have to play the shell game with board members and management, because you are the management. It is understandable and easy to get distracted by the rage and yes, envy, that one feels at these “fat cats” making so much money. But let’s get real honest now. Here, I’ll go first:
1. I’d love to make 1.2 million dollars a year.
2. I live in a capitalist system, not a caste system, which means that just because I was born in a capitalist system I don’t have to live here, or, I can try to alter the system to be more in keeping with my socialist goals. But as long as I live in a capitalist system, money is an inevitable fact of my existence.
Now the hardest one, at least for me:
3. The minute I accept insurance reimbursement I become part of the medical establishment, and that means that the sickness and suffering of others is what creates a need for the commodity of psychotherapy. In other words, I need a steady stream of unwell or hurt people in order to make my living. If I do my job well enough, people won’t need me any more, and I’ll need to attract other hurt or unwell people. And even if I try to gussy it up in the form of “self-help,” I’ll still need people who need help.
Now I am not going to try to justify this to you, gentle reader, by saying I only make as much money as I need. I don’t believe greed is good, but I do want an iPad, and I don’t need an iPad. So I have to come clean and admit that I am not an non-profit.
I consult so often with therapists who take great pride in the amount of “slide” they have in their sliding scale. They are willing to give up that money without a lot of regret. Until they take out that picture of their family that I ask them (and now you) to put on the office desk. Look at it, at them. Those are the people you love, they are also being affected when you don’t charge full fee to someone who just got a new job, or when you don’t enforce your cancellation policy. They are the ones who are depending on you to help keep your family afloat. They are the ones who embody the best care you can give, and they will be with you and counting on you the rest of their lives in one way or another, often financially.
You are not a non-profit. You need to make a profit, and you need to stop pretending you don’t, and minimizing the profit so that you can pretend. I hate insurance companies and a lot of our healthcare system, and I am fighting for social justice when I am not working in my practice. But these companies get it, they get that they are in business.
We need to get that too.