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Corporate attacks on health care will worsen the already dismal plight of the disadvantaged and of minorities in America, said immediate past APA president Harold Eist, M.D., in an impassioned address to the House of Delegates of the National Medical Association (NMA).
Eist reiterated the strident opposition to managed care that he made a centerpiece of his presidency, expanding his comments to emphasize the global burden of mental illness and the importance of psychiatry in the future of world health.
The NMA is the nation’s largest association of African-American physicians.
"We see the future of psychiatry as inescapably demanding," Eist said. "Projections of the global burden of human disability and the U.S. Epidemiological Catchment Area studies indicate that psychiatric illnesses will become an increasing global burden, with major depression ranked second only to iscehmic heart disease by the year 2000. Schizophrenia will affect 25 million people in poorer nations by the year 2000, a 45 percent increase since 1985.
"Explosive urbanization has increased demands worldwide on already inadequate and underfunded services," he added. "It is factual that worldwide there never has been adequate funding for the care of the mentally ill.
"This is a global travesty," Eist said, "reflecting a universal failure in our systems of social justice, and it is soon to become worse in America with Medicaid and Medicare managed care."
Eist said that in America 1 in 5 to 1 in 10 of the mentally ill receives treatment, while worldwide the figure is approximately 1 in 100.
"We share with every civilized nation on earth uncivilized attitudes toward those with mental illness," he noted.
Yet Eist said there is a worldwide consensus for equitable health care services.
"Recent events clearly document not only a groundswell of activity for fairness in the face of strong corporate opposition, but an international torrent of such activity starting with the fall of communism and expressing itself in the recent American, British, and French elections, all of which document that people put the health of their nations before the wealth of their nations," Eist said.
"Without health there can be no wealth, certainly no enjoyment of wealth," he said, and he added that corporate estimates of health care costs fail consistently to take into consideration the value of healthy employees in productivity and profit.
"In 1992," he said, "the American Manufacturers Association reported that [its members] spent less on health care than they did on lawyers or the cost of government regulation. Health care was not breaking the bank."
Eist said that before corporate claims about health care costs can be accepted, a careful cost-benefit analysis is in order.
Eist asked: Is the corporation getting real value and increased productivity, increased profits, improved morale, reduced accidents, and reduced absenteeism?
He cited the June 16 Journal of Commerce, which reported that corporate America loses $29 billion each year in terms of lost productivity of employees who are providing care to sick or elderly relatives.
Eist added, "The cost of this often less-than-adequate care, and the cost of wear and tear on the caretakers, has not been determined."
Eist ridiculed the notion of extending access to health care through managed care. "[S]ince it isn’t ‘managed’ and it isn’t ‘care’—it’s mangled and driven by price, not clinical concern—it should be called corporate care," he said.
He added, "We have gone in America from a system providing health care with some abuse and fraud to a system of abuse and fraud with ever-diminishing amounts of health care."
Eist also told physicians in the NMA House of Delegates that psychiatrists have taken the lead in protecting the physician-patient relationship.
"We in psychiatry and our patients recognize the importance of this ennobling relationship, cherish it, nurture it, and understand that it is virtuous to defend and protect it at all costs," he said. "As part of our effort. . . the matter of confidentiality looms large.
"Confidentiality battles, led by psychiatrists, are raging at the federal and state levels," Eist said. "American psychiatry has taken a lead on this issue for American medicine and the American people. . . . This is part of our ethical responsibility. It is a moral responsibility, and society recognizes that this guardianship is a legal responsibility. Patients share information with us because they trust it will be used to help them. The industrial uses of information are exploitative, not used to help, and are often used to haunt."