Introducing Stephen Vernon, our newest unsung hero of healthcare reform! This project of HEAL California highlights the hard work and dedication of individuals who are working – often in the background – to win Medicare-for-All in California and the nation.
Stephen Vernon
Stephen Vernon, a marriage and family therapist in private practice and founding member of Therapists for Single Payer, sees single payer as a path for patients and therapists to wrest control of the therapeutic process from insurance companies.
Born in Pennsylvania and a graduate of Michigan State University, Stephen’s practice covers the entire Bay 
Area. He’s on the steering committee of the Bay Area chapter of Physicians for a National Health Program, and a board member of the California chapter of the American Association for Marriage and Family Therapy. He has experience in public health, substance abuse and mental health programs.
He remembers listening to the debate about Medicare when he was young and wondering why people should be left to die just because they didn’t have health insurance. Now, as a senior and healthcare professional himself, it makes even less sense to him.
For over 40 years, Stephen has dealt with corporate insurers, as well as Medicare and Medi-Cal, as a clinician and non-profit healthcare executive and personally, as a family member and consumer. From his perspective, insurance companies and the Managed Care model represent major obstacles to delivering quality healthcare to patients. The drive for corporate profit is a silent, toxic presence in the treatment room, harming both patients and clinicians.
Underfunding Mental Health Services
Over the course of his career, Stephen has watched the U.S. healthcare system, especially mental health services, become increasingly underfunded. And while the Affordable Care Act allowed patients more access to services, he believes the added bureaucratic maze has further complicated efforts by clinicians to help their patients.
“One big problem is the ever increasing value-based and outcome-reimbursement structure. It’s not appropriate for mental health (or any health care for that matter). With insurance companies and government administrators in charge, this type of structure distorts treatment and reduces the resources available for our clients. It emphasizes incentives for clinicians to decline the most difficult cases or those from the lower economic groups.”
He finds these schemes to be “destructive clinically and socio-economically.”
Another problem, says Stephen, is administrative complexity.
“The reality is multiple insurance companies mean multiple different kinds of paperwork and evaluative structures. We spend more time and energy on documentation and regulatory requirements, while our capacity to provide clinical services decreases. This process needs to change.”
Impact of Managed Care
Managed Care has only made things worse, according to Stephen. Three or four decades ago, Managed Care shifted mental health into a “medical necessity” framework. While sometimes appropriate, it’s far too limiting when it comes to mental health and mental illness.
“Clients don’t come to us with a broken arm, a bad back or a chronic “medical” disease. In my profession, for example, it might be better to return to the office more than once a week. But under Managed Care there was no way they were going to authorize services for more than once a week. Deep, traumatic issues take a long time to deal with. But you get a phone call every six months, and must reiterate the same thing about the client’s condition, progress and measurable goals. All with the very real risk that the insurance company might cut off services anyway.”
At the same time, around 1990, Managed Care more or less halved the mental health reimbursement rate and hasn’t raised it since. There is no negotiation. It’s “take-it or leave-it.” Meanwhile, the cost of living has doubled. This is one reason that the mental health profession has become less attractive.
“Managed Care consistently demands we do more with less. A ridiculous idea, made all the more so when you consider we already have way too little in services and practitioners.”
When it comes to compensation, mental health clinicians don’t have the leverage that other medical fields with large organized groups have. Instead of Medicare rates being the floor for negotiation, they are the ceiling.
Empower Clinicians: Medicare for All
Stephen believes a single payer system would allow clinicians more say in how they treat patients and more leverage to negotiate fair compensation. He sees the prospect of involving practitioners in the development of the service and payment structure as a powerful argument for single payer.
“With participation in the structure, reduced administrative load and collective bargaining, single payer will empower us. We will be able to negotiate rates and working conditions, much like unions. We will also be involved in developing the single payer structure. The maintenance of it will include strong, clinical, voices. Our clients will get more services, and we will have a more equitable voice in the process.”
According to Stephen, any system that has the profit-driven insurance corporations determining the delivery of care will never address the underlying problems.
“Insurance companies exist to generate profit—not provide services . . . if you’re providing service through insurance, you have to deal with their meddling. You have to get authorization multiple times. Even in the middle of a course of treatment, they will call you up, and you’ll have to convince them that they should continue paying, or underpaying really, for these services. I’ve had clients who had their authorizations cut back drastically or had their services cut short, arbitrarily, regardless of their clinical needs.”
“As psychotherapists are keen to promote, ‘We will have agency in our own lives!’’’
—
HEAL California is an independent news and information hub focused on the California Medicare for All movement. We feature non-partisan news, views, podcasts and videos that highlight the continuing failures of our broken healthcare system and elevate the voices of advocates and organizations fighting for change.
Check out our Media page for experts and additional resources including links to legislation, studies, and more.
Keep up with the California Medicare for All movement –
Follow us on Facebook and Twitter.
Subscribe –