By Catherine F. Brown

As members of APA's components gathered for their annual fall meetings in Washington, D.C., last month, the city was struggling from the effects of Hurricane Fran and a deluge that would soon turn into flooding. The fury of the weather outside, however, was insignificant compared with the fury of APA President Harold Eist, M.D., as he addressed the group of about 500 at a breakfast plenary session.

"It is clear and true that managed care that is simply managed prices is absolutely unaffordable and must go away," Eist declared to an enthusiastic response.

"You might ask, 'Why must we fight, since we are right?'. . . We must fight because, though we are battered, we must stop that which is destroying our field. Fighting will hasten both our salvation and our victory. In order to attain victory, we must act and act decisively over the coming year and for longer if need be—because we must not only win the war, we must also maintain the peace. . . .

"We compound our difficulties when we insist managed care is here to stay," he said. "Managed care companies know this to be untrue."

Eist has devoted much of his presidency to fighting the excesses of managed care and its bottom-line policies that have resulted in discrimination against the mentally ill and prevented many from getting the care they need. Under his leadership, Eist said, APA has begun to make some progress in addressing these issues and is devising strategies to take on the managed care industry, make parity a reality, increase research funding and training resources, protect the doctor-patient relationship, and ensure universal access to care.

"Our grand strategy includes expanding our own and the public's understanding of mental illness, expanding care for the mentally ill, research into its causes and cures, and necessary workforce growth. There is no medical or rational basis for contraction," Eist explained.

An important resource for reaching these goals, he said, is "people power." "We have the people on our side. Poll after poll documents this, as does our daily contact with patients. People power is the most important source of power in a democracy, though our representatives are unfortunately all too prone to forget this. We must enhance, expand, and focus this people power with clear incisive action initiatives."

Another important resource is money, Eist said. "We need money to be mature, political players in Washington and at the state level. Up until now, we have been relatively ineffectual in raising money for the education of the public and our elected representatives."

He challenged every APA member in the audience to give "10 bucks to parity" as he or she exited the hall that morning and announced that all APA members would have an opportunity to do the same when they paid next year's APA dues: Dues statements will include a box asking members to give $10 or more to establish a special fund for parity.

Moreover, he noted that APA is part of a mental health coalition with 500,000-members, whom he would be asking for $10 donations as well.

"This is the kind of money we need to push forward our agendas," Eist said. "Without the money, the likelihood of our success is significantly reduced. We have been hampered by a lack of money [but with a brimming] war chest, we will be undefeatable. Look what we've done with a pittance."

Eist noted that by parity, he means "real parity--not managed-care controlled parity, which will lead to more money going into the coffers of the managed care companies and lead to even less service than the mentally ill have today. In any parity legislation, we--the medical profession, psychiatry—have to define medical necessity, but the bottom-liners and we have to define medical necessity through a consensus of general clinical opinion combined with a thoughtful research consensus."

The claim that the marketplace determines what happens to patients and the medical profession is irrational, he said. "Once again, I must remind you that the market is not holy and that while markets set prices, they are incapable of recognizing costs and, as such, fail to recognize or acknowledge the key constitutional issue of fair equality of opportunity."

At the start of his speech, Eist reported that his continuous efforts at reaching out to APA members and making himself available to them were beginning to yield dividends. He noted that there has been an increase in member activity and communication with him and other APA leaders, whether via telephone calls, letters, faxes, or e-mail. But more still needs to be done, he said.

"We know what the majority of our members want. We know what our patients and their families need. We are inundated with their cries of distress on a daily basis."

And now the time has come to leave endless debates and traditional cautionary approaches behind and take decisive action, Eist said.

In ending his remarks, Eist charged the component members to spend half of their time discussing six "action areas": strategic alliances and public education, confidentiality and ethics, managed care, legislation and legal initiatives, medical education and research, and the AMA.

Components were then instructed to pass on their ideas and suggestions to the body they report to, with final consideration to be made by the Board of Trustees.

(Psychiatric News, October 18, 1996)