America Needs Single-Payer Healthcare, Not More Therapist Scheduling Apps

Lyra Health, the digital health company currently headed by former Facebook CFO David Ebersman, recently closed a $45 million series B round of funding including investments from Tenaya Capital, Glynn Capital Partners, Crown Ventures, and Casdin Capital.

“Three years ago, Lyra set out to help people navigate a cumbersome, fragmented, and opaque mental health system and we’re proud of the impact we are making with our employer partners. With this new funding, we look forward to creating technology-enabled experiences to deliver better, faster, and more personalized care.” — David Ebersman

According to Lyra Health’s website, the company is “transforming behavioral health from start to finish.”

If only that were true.

At its simplest, Lyra Health’s service is a scheduling app that connects employees at Lyra’s “employer partners” (i.e. clients) with therapists. It’s essentially the same service as Zencare, the mental health startup founded by Yuri Tomikawa that connects stressed-out Millennials with therapists in Boston as well as here in Rhode Island. The only real difference is that Lyra focuses on connecting patients with therapists through their employers, rather than giving patients the means to do it themselves.

There’s nothing “wrong” with patient scheduling apps. Finding a therapist is a pain in the ass. If technology can make it easier for mentally ill people to find the help they need, great.

The problem is that, for many people, finding a therapist isn’t the real hardship — paying for a therapist is.

According to TalkSpace, the average therapist in the United States charges between $75–150 per hour. In places like New York City, this can rise to between $200–300 per hour. These rates do not take insurance into account. Why? Because only 55% of psychiatrists accept common insurance plans.

In an interview with the Huffington Post, licensed psychologist Candice Ackerman explained that insurance companies seldom agree with mental health professionals’ diagnoses. This is because preventative mental health care — the kind of care that apps like Lyra Health and Zencare help people find — is rarely considered a “medical necessity.”

“Insurance companies tend to see things more from a medical perspective ― where if you get sick, for example, then you take a blood test, they figure out what is wrong with you, they give you a medication and then you are all better. But with mental health, a lot of times what we are trying to do is preventative maintenance-type work, and it makes it a lot more difficult to justify medical necessity with insurance companies.”

One explanation for this is the fact that mental health professionals apparently have bills, too. I read several articles that tried to use doctoral degrees (and the attendant student loan repayments) as justification for the rates used by many mental health professionals and the fact that many psychiatrists do not accept common insurance plans. While I’ve no doubt that this is indeed a factor in many therapists’ decision to refuse most patients’ insurance, this conveniently ignores the fact that everybody has crushing student loan debt to contend with. Degree inflation is a chronic problem across the United States, and more than one-fifth of Americans working jobs paying between just $12–16 per hour hold bachelor’s degrees or more advanced academic qualifications.

I find it difficult to sympathize with therapists’ plight when millions of people earning little more than minimum wage are struggling to repay student loans for bachelor’s degrees that are close to worthless.

Despite his company’s grandiose claims, Ebersman is right when he describes America’s mental healthcare system as cumbersome, fragmented, and opaque. But what’s misleading about Ebersman’s assertion is that he phrases it in such a way that it almost sounds accidental.

It isn’t an accident — it’s by design.

In an op-ed for The Baltimore Sun published last year, author and professor of public policy at the University of California-Berkeley, Robert B. Reich, described the “healthcare bill” that Republicans forced through Congress in the dead of night as “the largest single transfer of wealth to the rich from the middle class and poor in American history.” Reich is absolutely correct. In fact, if we take Reich’s observations a step further and apply them to America’s heathcare system as a whole, it begins to make a lot more sense. In America, healthcare outcomes are incidental to the transfer of wealth from patient to provider. The real goal isn’t to cure disease, but to treat its symptoms. Curing disease is not a sustainable business model.

“The potential to deliver ‘one shot cures’ is one of the most attractive aspects of gene therapy, genetically engineered cell therapy, and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies… While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.”

If given the choice, private enterprise will always prioritize profits over patient healthcare outcomes. The only way to improve healthcare for patients in the United States is to eliminate the profit motive, and the only way to do that is to transition to a single-payer system.

There is a place for apps like Zencare and companies like Lyra Health in America’s mental healthcare system. If nothing else, at least Lyra is trying to reduce the social stigma of seeking mental healthcare services and make accessing these services slightly easier. However, Lyra’s claim that it is “transforming” mental healthcare is nothing more than a shallow, meaningless marketing ploy.

Until we make mental healthcare affordable as well as accessible, millions of Americans will continue to go without the potentially life-saving care they need. Entrepreneurs like Ebersman may think they’re transforming healthcare, but if this is true, then it’s painfully evident that Silicon Valley isn’t thinking big enough.