New Challenges for Proven Values: Defending Access, Fiarness, Ethics, Decency By Herbert S. Sacks, M.D. APA President

The position statement "Toward the Millennium: Achieving Universal Access to Psychiatric Care in an Era of Revolutionary Change," adopted by the Assembly and Board of Trustees in late 1995, dwelled upon principles providing us with navigational aids as we steam at flank speed toward the millennium.

This position statement was prescient. If our colleagues want to know what APA believes in today and where it is heading tomorrow, show them this paper. I recommend it to you for your close reading. We have copies available for you by calling the APA Answer Center at (202) 682-6000 or visiting APA's Web site at the URL address . The document is also available on the APAfastFax service under document code 3401. To use this free service, callers in the U.S. and Canada should dial (888) 267-5400; outside these areas, the number is (503) 402-1365.

Working for Access

Today's reimbursement systems impute that we psychiatrists don't know what's good for our patients. Faceless, unqualified reviewers define our work, remove our colleagues from panels, and routinely breach confidentiality. But there is a bright future ahead! In the past two years a sea change of public opinion has compelled legislative action. And the oldest medical specialty, psychiatry, has led the counterattack, gathering new allies and advocates each day. Joining class-action litigation as a plaintiff is our newest effort to counter the degradation of high-quality patient care.

Our drive for access continues. Within the cohort of the uninsured 42 million Americans is the most vulnerable and powerless segment of our population, our children, who have been especially victimized by brokered deals agreeable to both sides of the aisle. We demand health insurance for the 10 million uninsured children of working families who are not eligible for Medicaid. The recent bipartisan budget agreement, not yet drafted into legislation, will extend coverage to 5 million uninsured children. Will our nation continue to invest in pork-barrel defense projects that we don't need and reduce capital gains taxes while 5 million children go uncovered? We demand nondiscriminatory coverage for the treatment of children and adolescents with mental disorders. Why now? President Kennedy said it best when calling for new civil rights legislation in 1961, "We have to do it, because it is right." A nation is measured by how it treats its children, and we have failed the test.

Defending fairness for patients has been an uphill battle against corporate organizations disconnected from compassion, human suffering, and science. The simplest elements of decency and respect for human dignity must not be sullied by seemingly irresistible market forces. A weakening of ethical values occurs when insurance dictates control medical practice standards.

Help Welcomed

An important group of our members are part-time employees of managed care organizations (MCO's). Under the big tent of organized psychiatry, the debate with MCO's continues, but with agreement on both sides for greater accountability, better outcome studies, and the elaboration of prevention strategies. APA will work to neutralize the adverse impact of MCO's upon research, education, and, ultimately, recruitment to this exciting field. We welcome members who work for MCO's joining us in this effort.

Profit-driven managed care is not the high road to better psychiatry, but is a route to the erosion of the psychiatrist's responsibility, poorer quality care, and no less expensive care. The primacy of the trusting covenant between the doctor and patient must be preserved. APA will continue in the vanguard of medicine in setting clinically sound guidelines and preserving the integrity of our publications and the high quality of our scientific meetings.

Resolute and more determined than ever, we look to brighter days ahead, when respect for the proven values of fairness, ethics, and decency will be vouchsafed.

(Psychiatric News, June 6, 1997)