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By Ken Hausman
Tiffany Ho, M.D., insists that a large dose of pragmatism mixed with considerable idealism will go a long way toward making sure that good ideas succeed and become law in the often arcane ways of Capitol Hill.
"You have to be persistent, patient, and really believe in what you are talking about. Also, you can't forget that change does not happen overnight," and that opponents are laying in wait to try to undo your best efforts, Ho emphasized.
What makes her perspective on the rarified atmosphere of federal lawmaking unique is that she is a psychiatry resident who for several months has been a Congressional insider.
Ho and her colleague Pablo Sadler, M.D., are nearing the conclusion of six-month terms as Daniel X. Freedman Congressional Fellows. The program, with grant money from the American Psychiatric Foundation and Eli Lilly and Company, supports senior psychiatry residents who have a serious interest in public policy and the legislative process while they work for a member of Congress or Congressional committee.
Ho, a fourth-year resident at the University of California, San Francisco Medical Center, is a staff member for the House Ways and Means Health Subcommittee, where she works closely with ranking Democratic member Representative Fortney (Pete) Stark of California. Stark, one of Congress's most influential voices on all health-related matters and a consistent advocate of mental health issues, chaired that powerful subcommittee for many years.
She said in an interview with Psychiatric News that years of advocacy work since her undergraduate days provided the foundation for her enthusiasm about the ability of policymakers to improve the lot of many people. She has also been involved in the Northern California Psychiatric Society and the APA Council on International Affairs, she said. In addition, Ho has volunteered her medical services in Vietnam, Honduras, the Dominican Republic, and Jamaica.
Her Capitol Hill tenure has enabled her to put her expertise to work on several key issues, including managed care and the development of a patients' bill of rights. She has also worked on an effort to achieve greater parity for mental illness care, medical records confidentiality, and the Asian and Pacific Islander Health Initiative, which is trying to increase access to medical care for those minority groups and ascertain what unique health-related issues need to be better addressed.
Sadler has worked on some of the same issues on the Senate side, a patients' bill of rights and medical record privacy chief among them. Of late, he said, he has been spending a substantial portion of his time on tobacco-regulatory legislation commonly known as the McCain bill, for which he evaluates proposals and amendments for Senator Barbara Mikulski (D-Md.).
When it comes to mental health issues in particular, Ho suggested that one crucial but troubling lesson she has learned during her months in the House is that they are still a hard sell in Congress. She attributes this state of affairs to some members' mistaken perceptions that mandating increased benefits or access will drive up program costs whenever such proposals are included in legislation, and that without controls on usage people will abuse mental health benefits. Ho also said that she has heard lawmakers assign mental illness issues a low priority because "they don't associate it with a risk of death" as they do when they are asked to vote on a matter concerning heart disease or cancer, for example.
For Sadler a major surprise has been "the power that lobbying and special interest groups exert" on the legislative process. "They provide about 90 percent of the information and resources that Congress uses to make decisions, and often they even create a need for legislation," he told Psychiatric News.
Sadler, a native of Buenos Aires, Argentina, is completing his fourth residency year at Montefiore Medical Center in the Bronx, N.Y., and has a master's degree in public health from Hebrew University in Jerusalem, Israel.
He is on the staff of the Senate's Labor and Human Resources Subcommittee on Aging, where he works closely on health issues with Mikulski, the committee's ranking Democrat. In addition, he is the representative of the World Association of Psychosocial Rehabilitation to the United Nations.
After five months on the Hill, one of the only disappointments Ho said she has is that the Congressional members and staff with whom she works are still not making optimal use of her psychiatric expertise, particularly when it comes to substance abuse and addiction issues.
Sadler, too, regrets that Senators and staff members sometimes show little interest in hearing a physician's point of view when they are in the midst of evaluating issues affecting medical care and the nation's health care system.
He said he realizes, however, that in light of the pressures that never seem to let up on the Hill, "there just won't be many chances to discuss the big picture or more global concerns."
With the end of their Capitol Hill sojourn just weeks away, both Freedman fellows described their experiences in glowing terms.
Sadler declared his as "great-a tremendous learning experience," adding that he felt comfortable during his entire time in the Senate. He pointed out that he was "surprised by the openness" he encountered and the ease with which he was able to participate in meetings and discussions on the topics that interested him.
After leaving the Hill, Sadler plans to return to New York, where he will become chief resident at Bronx Psychiatric Center and begin a public psychiatry fellowship at Columbia University.
Ho maintains such a positive view of her Washington experience that when it concludes in a few weeks, she will shift branches of government and become a full-time employee of the Center for Mental Health Services in suburban Rockville, Md., where she will continue to work on mental health policy issues.
"I believe it's our responsibility as mental health professionals to influence policy on those issues any way we can," Ho said.
The Freedman fellowship allows a senior psychiatric resident-for the first time this year, two residents-to experience the legislative process as an insider. Now in its fourth year, the fellowship is named for former APA President Daniel X. Freedman, M.D., who was a forceful proponent of the idea that psychiatrists must be involved in the political process for the good of their patients and their profession.
Ho declared the fellowship "a great opportunity" and enthusiastically urged other residents to apply.