This pricing is a *per se* antitrust violation of Section 2 of the #ShermanAct, America's original #antitrust law. That's important because Sherman 2 is one of the few antitrust laws that we never stopped enforcing, unlike the laws banning predator pricing:

https://ilr.law.uiowa.edu/sites/ilr.law.uiowa.edu/files/2023-02/Woodcock.pdf

Uber claims an 11% margin improvement. 6-7% of that comes from algorithmic price discrimination and service cutbacks, letting it take 29% of every dollar the driver earns (up from 22%).

22/

Few therapists will do so -- but we could get away with concierge fees like doctors. My old primary care doctor took insurance AND had a low concierge fee. I was happy to pay it.

My old business partner and I used to half-joke about having a "Cigna Fee". At that time Cigna was being so much of a pain with billing and third party credit card payments that we were paying significant money to an outside biller in hourly fees to sort their mess out. I think we could have gotten away with it -- the plan was to have a fairly low one-time or once per year fee about equal to an hour of a biller's time.

#psychology #counseling #socialwork #psychotherapy @psychotherapist @psychology @socialpsych @socialwork #union #unionizing #pay #healthcare #reimbursement #ShermanAct #APA #ACA #NCSW #inflation #wages @psychiatry

A century after overthrowing the King, America had new kings: "kings over the production, transportation and sale of the necessities of life". That's how Senator John Sherman described the situation in 1890, when he was campaigning for the passage of the #ShermanAct, the first "anti-trust" act.

5/

In other words, rather than using market mechanisms too constrain platform twiddling, Dubal just wants to make certain kinds of twiddling illegal. This is a growing trend in legal scholarship. For example, the economist #RamsiWoodcock has proposed a ban on surge pricing as a *per se* violation of Section 1 of the #ShermanAct:

https://ilr.law.uiowa.edu/print/volume-105-issue-4/the-efficient-queue-and-the-case-against-dynamic-pricing

54/

This pretense of mathematical perfection through monopoly ignores the problem that anti-monopoly laws seek to address, namely, the corrupting influence of monopolists, who wield *power* to control markets and legislatures alike. As Sen John Sherman famously said in arguing for the #ShermanAct: "If we will not endure a King as a political power we should not endure a King over the production, transportation, and sale of the necessaries of life."

https://marker.medium.com/we-should-not-endure-a-king-dfef34628153

9/

These wages no doubt look pretty good to some people. A few points about that:

a) Psychotherapists are paying off student loans for masters and doctoral degrees.
b) These are pay rate examples for self-employed psychotherapists. Rent, utilities, overhead, vacations, and sick time all come out of our own pockets. These rates are not take-home pay -- we are contractors, not employees.

I now know people in their 30s making $85K in public relations and marketing who feel underpaid. I have a former Medicaid client now making $120K (and gods bless, they deserve every penny). Other therapists I talk to point out:

-- moonlighting teachers command $90/hr. for tutoring

-- hairdressers, dog groomers and tutors get paid in cash and don’t have to carry liability insurance or be on call

-- "$65-$75 per head for cut & blow dry in my suburban area. Approximately a 30-45 min service. No waiting 30-45 days to be paid. Cash in hand. No notes to keep. No files to maintain. No clawbacks. Not on call for emergencies."

-- "Ins fees for 90834 range from $48 for the market place plan to about $80-$84 for BCBS. The average fee appears to be about $67 to $77." [This varies by area of the USA.]

Doctors, nurses, and other healthcare professionals have plenty of problems -- but seem to do better in pay negotiations. Teachers are underpaid, but largely get to benefit from unions. Psychotherapists need either the ability to organize/unionize -- or national associations with the money and capabilities to fight for better wages and take on big-money insurance interests.

-- Michael

#psychology #counseling #socialwork #psychotherapy @psychotherapist @psychology @socialpsych @socialwork #union #unionizing #pay #healthcare #reimbursement #ShermanAct #APA #ACA #NCSW #inflation #wages #insurance #healthinsurance

@Email2TootBot

Email2Toot ROBOT -- CHECK ACTUAL AUTHOR BELOW:
.
.

TITLE: Declining Psychotherapy Reimbursement in Inflation-Adjusted
Dollars & the Inability of Psychotherapists to Collectively Bargain or
Really Have Any Power at All in Their Reimbursement

(Posted for anonymous author by Michael Reeder LCPC -- I did not write
it myself but wish I did :) )

~~~

My Medicare reimbursement for 45 minutes of psychotherapy in 1990 was
$86.82 (in my region -- I have billing records back to 1985, but
Medicare did not contract with psychologists until 1990). Currently it
is $91.38 (Santa Barbara County), but minus 2% sequestration, it is
actually $89.55.

You can find your region's version by searching 2023 Medicare Physician
Fee Schedule (using the name of your state -- and also searching
reimbursement rates by year). ____

Using the US Bureau of Labor Statistic's inflation calculator____

https://www.bls.gov/data/inflation_calculator.htm

which BTW is the most conservative with regard to inflation.

$86.82 in 1990 had the same buying power as $204.05 today. $89.55
divided by $204.05 equals 44% -- i.e., a pay cut of 56%.____

In year 2000, in my region Medicare paid $95.89 for 45 minutes of
psychotherapy (then coded 90806, now coded 90834). ____

Using the CPI inflation calculator, $95.89 in year 2000 had the same
buying power as $169.89 today. In my region, Medicare currently pays
$105.02 for 90834 -- but reduced 2% for sequestration, actually pays
$102.92. $102.92 divided by $169.89 = 61%, so only a 39% pay cut. That
also tells us that reimbursement dropped 17% between 1990 and year 2000.____

The biggest impediment to negotiating with insurers is a legal
precedent from the late 1970's that prohibits psychotherapists from
engaging in collective bargaining. Theoretically under the Sherman Act
of 1890, we might form 'trusts' to set fees and control the market.____

As absurd as this sounds, it has become even more absurd since the
advent of managed health care in the 1980's and our ability to
participate as Medicare providers in 1990. ____

Insurers create contracts in which they unilaterally set reimbursement
rates, documentation requirements and other working conditions. Although
we are all given the same contract, and are thus treated as a class of
workers, we are legally prohibited from negotiating contracts as a group
of workers.____

Last week, I wrote (again) to APA's legal team, asking them to
prioritize this issue. Historically, professional associations beg off,
arguing that they lack the resources to take on trillion dollar a year
private insurance corporations, much less the federal government.____

Please let your professional associations know that the right to
collective bargaining is a crucial issue, and in the context of
reimbursement that is less than half what it was in 1990, perhaps the
criterion issue for the survival of our profession.____

#psychology #counseling #socialwork #psychotherapy
@psychotherapist @psychology @socialpsych
@socialwork #union #unionizing #pay #healthcare #reimbursement
#ShermanAct #APA #ACA #NCSW #inflation #wages

There have been lots of other abusive "platform" businesses in the past - famously, 19th century railroads and their #RobberBaron owners were so obnoxiously abusive that they spawned the #trustbusting movement, the #ShermanAct, and modern competition law. Did the rail barons do enshittification, too?

10/

That is, Bork claimed that a close reading of existing antitrust laws - the #ShermanAct, the #ClaytonAct, the #FTCAct - would reveal that Congress didn't want regulators or judges to prevent or break up monopolies. No no no! These laws were only drafted to punish *bad* monopolies.

A "bad monopoly" is one that uses its market power to raise prices or lower quality.

9/

#BREAKING - The #DOJ has filed an #AntiTrust suit against #Google , regarding its dominance in the #OnlineAdvertising market. #MerrickGarland says that Google has been using "anticompetitive, exclusionary, and unlawful means to eliminate or severely diminish any threat to its dominance over #digital #advertising #technologies ."

#Monopoly #Monopolies #USgovernment #DeptofJusticeGarland #ShermanAct #ShermanAntitrustAct #Advertising #Ads

https://amp.cnn.com/cnn/2023/01/24/tech/doj-google-lawsuit/index.html

@chin “slam-dunk Sherman Act §2 violation”. I’m having trouble figuring that. (Not endorsing appalling conduct of #BirdSite but wondering about #ShermanAct analysis…)

https://www.spreaker.com/user/lokiluckiii/episode-1085-the-war-on-google
#antitrustlaws, #bigtech, #censorship, #culturalmarxism, #demoniacresistance, #google, #mindcontrol, #nullification2020, #occupytyranny, #publiccollege, #shermanact, #technocracy, #usdoj