We Are Winning Battles and We Will Win the War

By Harold I. Eist, M.D.
APA President

We are winning. Yes, though we remain seriously embattled, we are winning. As I indicated several years ago, at a time when HMO's and managed care companies were rolling up huge profits in a financial blitzkrieg detrimental to care, Wall Street was recommending against investment in their stocks.

True, Wall Street has no special wisdom but it could see that the entrepreneurs in the care delivery systems were middlemen vulnerable to removal. Economist Uwe Reinhardt in a recent Medical Economics article predicted the medical profession would recapture health care from the grips of the MBA's. Psychiatric Times reported "Large employers began to flee HMO's." Honeywell dropped all its HMO's for its salaried employees in the Minneapolis-St. Paul area. Business believes that HMO's have been guilty of deception and are not saving money.

There is a profusion of negative reporting on managed care in all the media. I believe we are seeing more Op Ed pieces and letters critical of the harmful practices of managed care in newspapers than at any time in our history. We are fighting back. We are fighting the lies, distortions, and misleading advertising. Uwe Reinhart stated, "The most fundamental fraud and abuse in health care is the notion that market forces can control health care costs without altering the distribution ethic governing our health system."

We are not responsible for the advent of managed care. One of the Big Lie mantras we must challenge every time it comes up is that abuses of long-term psychotherapy begged for managed care intervention. Even if all long-term psychotherapy was and is an abuse (which obviously it is not), it accounts for such a small cost of health care—a fraction of a percentage— that it has had virtually no impact whatsoever on escalating health care costs. Cost-offsets, however, establish that it has actually reduced costs and more than paid for itself.

The Baltimore Sun (July 21) reported on HMO's in financial trouble and Consumer Reports (August) indicated the benefits of HMO's were a "mirage." AM News recently indicated HMO's were giving up the idea of gatekeepers. As I have stated repeatedly over the years, gatekeepers add another layer of bureaucracy and delay access to the correct care, thereby actually increasing costs. What is managed care without gatekeepers? Either a point-of-service system or a private-practice system. Consumer Reports also contained a box advising people on how to deal with managed care. We are in the process of developing our own APA brochure on "Managed Care and Your Health." I would suggest that you post the Consumer Reports recommendation in your waiting room until you get our brochures.

We are winning but we must press on, work harder, and take advantage of every opportunity. Both political parties, as Senator Pete Domenici stated, behaved shamefully in the parity struggle. However, it is not over. We are told we will have another chance at parity this month and we must and will mount the strongest effort on behalf of parity that we ever have. We will do this in concert with our strengthened and broadened coalition and with a public that is solidly behind us. Being right gives us tremendous ethical and moral strength and an advantage over those who would dismember care for a profit. In addition to our ethics, our sweat, and our toil, however, we need financial resources to conclusively win the parity wars. Funding the victory for parity is essential.

Parity was rejected, we are told, because corporate America does not like mandates. Corporations are licensed by the state and given a mandate to perform functions that might otherwise inure to government. Corporations, like governments, must abide by the only body that can require mandates— the people. It is astonishing chutzpah that organizations licensed by the state and given preferential tax status by the state, should block parity because it is mandated.

Parity is the people's mandate for fairness, and we must leave no stone unturned to ensure that the people prevail. The house of medicine has not as yet developed, organized, and maintained a sustained battle against the depredations of managed care. Organized psychiatry is doing this now. We will not let the public or our profession down. To succeed, we must follow the advice of Mary Elizabeth Lease, who said in 1890 to the Grange in fighting the robber barons, "What you farmers need to do is raise less corn and more hell!"

(Psychiatric News, September 6, 1996)