Summer 2000

President's Report

by Karen Shore, PhD

Rescue health Care Day And Beyond

RESCUE HEALTH CARE DAY

Well, the dust has settled and hopefully, we have all had a little time off since April 1, 2000. More cities than I was aware have held marches, rallies or teach-ins, and it seems that everyone had a great time on April 1st. The purposes of Rescue Health Care Day (RHCD) were to declare a national vote of "No Confidence" in managed care, raise awareness of the problem and state clearly that managed care must be replaced, and to initiate a national dialogue on alternatives to managed care. A theme used by many of the rallies, "Blow the Whistle on Managed Care" made for wonderfully noisy and invigorating demonstrations. Our thanks to Jamie Court of Consumers for Quality Care and co-author of "Making a Killing: HMOs and the Threat to Your Health," for giving us this idea. My family's "Don't Rain Dance" that we have been doing for 35 years and has never failed, worked again. We should all thank the Long Island RHCD crew for overcoming their inhibitions and dancing the Don't Rain Dance with me. Just about the entire nation enjoyed sunny and warm weather on April 1st. In New York, April 1st turned out to be just about the ONLY nice, warm day in April!

The attendance ranged from 50 to 300 people at the various sites. The cities and regions involved were Fresno, Los Angeles, San Clarita, San Diego, and San Jose, all in California; Denver; New Haven, CT; Washington, DC; Atlanta; Portland, ME; Baltimore, MD; Trenton and Union, both in New Jersey; New York City, Buffalo, Albany, Duchess County, Hudson Valley region, Mineola, Stony Brook, and Ulster County, all in New York State; Asheville, Durham, Greensboro, Winston-Salem, Charlotte, Wilmington, and Raleigh, all in North Carolina; Cincinnati and Columbus, both in Ohio; Portland, OR; Orlando, FL; Pittsburgh, PA; Austin, TX; Seattle, WA; Madison, WI; and Huntington, WV. If my information is accurate, there were 37 cities involved. Most of the organizing and attendance at the rallies involved a combination of consumer and professional groups, varying in their balance between the two. Some were heavily clinician-driven. Others, like New York City, had heavy support from both professional and consumer groups, and the Washington DC rally was fully organized by consumer groups. Most had consumers who have been harmed by managed care and health care professionals addressing the crowds and some had legislators, too. The best part of all the organizing I have done over the past eight years has been the wonderful people I have met. When you get down to it, people are what its about and why we are all activists in the first place. It's about us, our families, our friends, our communities, and our nation as a whole. It's about people. It is about the desire to have a physically and mentally healthy nation.

There were two chief accomplishments. One was the excellent press coverage that our small band of rebels attracted. RHCD made television and newspaper news all over the country, increasing public awareness of the problem of HMOs and other forms of managed care and clearly stating our desire to replace the system. The other major accomplishment was that the RHCD effort attracted about 250 consumer and professional organizations. Ron Bronow, M.D., and Physicians Who Care became cosponsors early on and were crucial to the growing momentum. Both Ron and I and all those who worked on RHCD greatly appreciated the support of these 250 organizations. These organizations can now continue to work together and expand the effort to overthrow the managed care system and replace it with something better.

The biggest lack of success was that we did not get thousands at each rally. All those who want to see managed care end but who did not take the two hours or so to attend have to ask themselves why they did not contribute to a show of strength and support for the event.

The greatest achievement is yet to come, though, and this is the creation of a pro-patient, pro-quality system of health insurance. One of the contacts we made was with an organization called U2K--universal coverage in 2000. U2K is an organization of organizations from the consumer, union, and faith communities who want to create a better system. U2K was instrumental in organizing the Washington DC and the New York City RHCD rallies. They have a growing list of members of Congress who want to listen to them and work with them.

The binding principles of the group are to push for universal coverage and access, a comprehensive plan, affordability, quality, and public accountability. Others, such as the NYC groups, want to add the principle of the autonomy of the patient-practitioner dyad. The discussion is open to all who wish to take part. U2K is a politically savvy group of good people and I believe they will have a strong impact. Thus, the National Coalition of Mental Health Professionals and Consumers chose to work with them. We want to be at the table when ideas for a new system are discussed. Board members Patricia Dowds, PhD and David Byrom, PhD are our representatives to the U2K steering committee.

As you recall, all political points of view were invited to participate in RHCD and use it to promote their own ideas using any RHCD format they wished.  Most rallies remained focused on exposing the problems of managed care and calling for its end.  Some rallies added a focus on what they would want to replace it.  My observation was that both the single-payer folks and the anti-single-payer folks were both suspicious at first and avoided RHCD.  However, as time went on the single-payer supporters seemed to become more organized and used RHCD more than those who favor ideas like medical savings accounts.  My observation is that those who support government/single payer plans seem to be organizing strongly and including consumer organizations in their efforts, whereas those who are opposed to government plans did not use RHCD as a platform as much as they could have and do not seem to be joining with consumer groups as much.  I could be wrong about this…it is simply what I have observed.  My sense is that consumer backing is needed for any plan to be accepted on a large scale as an alternative to managed care.  These are just my observations and I am not sure if they are accurate, but I thought they were worth mentioning.  My personal opinion (not necessarily the opinion of the Board and not any official Coalition policy) is that there are important ideas from both the left and the right, and I have some concerns about ideas on both sides of the spectrum.  Thus, I still would like to see all perspectives being discussed openly so that each point of view can have some influence.

There are several groups that want to continue the RHCD effort and have started talking about and planning RHCD 2001. Activity is beginning in New York City, for example, and the U2K movement is in support of a continued Rescue Health Care effort.  For those who are interested in continuing with the RHCD theme, we have set up a new listerserv, called Rescue Health Care (rescuehc@egroups.com).  As before, this listserv can be used by people from any political point of view that want to join together to bring an end to managed care, share ideas, and work on a better solution.  If you would like to consider organizing a RHCD 2001 event in your area, begin NOW! You need to work with consumer and professional groups and involve as many as possible right away. Consumers are the key. The date for a national RHCD 2001 event is open at this time and up for discussion. The sharing of ideas for organizing through the listserv will make everyone's job much easier than our communications system last time. All who participated learned a great deal and have a lot of suggestions to offer for the next RHCD.  If you are interested, join the listserv by visiting the website at http://www.egroups.com/group/rescuehc.

Again, my thanks to all who gave time, effort, ideas, and/or money to Rescue Health Care Day 2000.... and especially to our entire board, our membership and the person who worked harder than anyone and without whose help we could not have done it: Kathleen Saccardi, our Office Manager.

THE YEARS TO COME

On June 9th and 10th, the Coalition's Board had another in-person board meeting.  As many times before, the Board enjoyed each other's company and worked hard to plan our future. I'd like to share with you some of what we have planned.

Unfortunately, Peter Gumpert, PhD, Sheri Larivee, Harold Eist, M.D., and Charles Zadikow, PsyD, were not able to attend.  We missed them and hope to see them at our Fall Board meeting.  There are a few changes on our Board of Directors.  Losses to us, Harold Eist, M.D. and Robert Dobyns, M.D., ended their terms and were not able to sign on for another term.  In recent months, Ken Anderson, Esq., Sheri Scott, a consumer and consumer advocate, Bill MacGillivray, PhD, and David Goldman, M.D., joined the board and at our June board meeting, we voted Kathie Rudy, PsyD onto the board.  Sheri has been helping the Coalition on a number of projects for quite some time.  Kathie was an incredibly hard worker all during the RHCD effort. She built and maintained our RHCD website and will continue in this capacity, also taking over the Coalition's website.  As a matter of fact, Kathie did such a great job on our RHCD website that when Sheri Scott wrote to her state's (FL) governor about managed mental health care, she received a letter from the governor's Agency for Health Care Administration saying that they had visited the RHCD website and commended the Coalition on its usefulness and quality!  David Goldman has worked with the Coalition's NYC affiliate, the Alliance for Universal Access to Psychotherapy, and with the New York City District Branch of the American Psychiatric Society for years and Ken Anderson has worked with the Coalition and the Alliance for several years on legal solutions and lawsuits.  Bill MacGillivray was a founding member and leader in the East Tennessee Coalition of Mental Health Professionals and Consumers and is active in Division 39 (Psychoanalysis) of the American Psychological Association.

Michaele Dunlap, PsyD is working on developing our Advisory Board.  Thus far (7/2/00) those who have accepted membership on this Board are Drs. Eist and Dobyns, Mary Kilburn PhD, Joyce Edward CSW (a co-founder of the Coalition), Sandra Bloom MD and Bertram Karon, PhD.  More are being asked and we will let you know as the board develops.  The purpose of this board is to advise the Board of Directors when needed and to demonstrate support from a very distinguished list of members.  Michaele is also working with the American Mental Health Alliance and would like to see how she can help clinicians have and use a web presence through AMHA to promote their practices.  In addition, she would like to develop a consumer guide and a directory of anti-managed care organizations.

As above, a major goal has always been to help bring about a better system of health insurance.  Working with U2K and other organizations, we now have the opportunity to truly participate in building a better system and making sure there is an adequate mental health benefit - both for the seriously mentally ill and for the non-SMI population.  Drs. Patricia Dowds and Dave Byrom will be doing the bulk of the work on this effort and are extremely devoted to working toward universal coverage and access to quality care, including good mental health benefits.

Deborah Peel, M.D., is our Legislative Chair. Deborah has been an active with the American Psychiatric Association, the Texas Medical Association, the American Psychoanalytic Association, and the Texas Medical Association.  Further, she has just begun a yearlong term as President of the Texas Society of Psychiatric Physicians.  She is also a great fundraiser in the Democratic Party and has contact with members of Congress.  She will be working on patient’s rights and privacy.  And great news--she also intends to update and bring back the Lobbying Kit.  During 1993 through 1996 I had produced and updated the Lobbying Kit.  Many members found it extremely valuable in helping them approach their legislators.  Its return will be a boon to our members.

Also, Pat Dowds and Dave Byrom just ended four or five years of service as our newsletter editors.  They did a superb job and we have all been very proud of the newsletter.  Their dedication and hard work are much appreciated.  They have passed the newsletter into the able hands of Bill MacGillivray.  Bill will no doubt continue to provide you with the information you need to stay on top the managed care and health insurance arena.  Pat and Dave will continue to work with Michelle at our office through the Administration/Development/Finance Committee and will add the task of working with other organizations to design a better health care system.  Attorney Ken Anderson plans to finish the process of creating a Foundation for the Coalition, as this would be helpful in seeking larger donations than we have had in the past.  As Charles, Peter and Sheri Larivee were not in attendance, we will have to wait a few weeks until our next phone meeting to see what they hope to bring to the Coalition membership this coming year.

One big change that will take place has to do with the Coalition presidency.  After eight years of being the Coalition's co-chair, chair and then President, I will be stepping down from the Presidency in June 2001.  As you know, I have devoted a great deal of time--usually between 10 and 30 or more hours/week--on Coalition business.  I wanted to make a real difference and could not tolerate the thought of leaving managed care in place.  I believed that I saw the damage it could and would do before most others.  Despite the many names I was called in the beginning, I was determined to keep saying what I believed and foresaw.  Pretty much everything I had said would happen did happen and now my views are fairly mainstream…or at least no longer considered outlandish or radical.  I now feel that we as an organization have a good reputation as hard workers with ideas, we are connected to hundreds of other organizations, and we have a strong board that wants to continue working to protect choice, privacy, quality care, and the patient's and clinician's decision-making power.

Next year I will step back some-not fully, but some.  I plan to stay on the Board to continue my political activity, but I also want to devote some time (finally) to developing my practice, learning, and playing a little more.  The Board voted Deborah Peel as our President-Elect.  Deborah is smart, strong, experienced, competent, knowledgeable, politically connected, and as passionate as I have been in her desire to replace managed care.  Deborah's first term (and I hope there will be more than one) will run from June 2001 to May 2003.  She will undoubtedly serve us extremely well.

However, I'm not done…. and here's what I aim to do in the year to come:

 ATTACK ON THE PHRASE "THE WORRIED WELL"

This phrase, "the worried well," has always infuriated me.  It seems demeaning, insulting, and dismissive of people who are truly in pain.  I have never had a "worried well" person walk into my office.  The Coalition has always spoken to the need for high quality mental health care that is accessible to all--the seriously mentally ill and non-SMI population.  We continue our full support for generous benefits for the seriously mentally ill, and I am delighted to see what I feel is a beginning awareness amongst policy-makers that the SMI population must be included in health care reform.  At the same time, it is becoming clear that policy-makers still fear what they perceive as "runaway costs" for the non-SMI population who largely seek psychotherapy and sometimes psychotherapy plus medication.  The notion that policy-makers are buying is the notion that those who are not seriously mentally ill are merely the worried well--people who are basically fine but whine and worry about little things that only require a brief therapy.  This creates outrage in me.

I intend to publicly declare and inform policy-makers in as many places as possible that there is no such thing as the worried well.  The people who are not seriously mentally ill but who seek outpatient care are people in pain-usually a great deal of pain--and have a great deal of work to do in regard to depression, anxiety, interpersonal and family problems, substance abuse, unhealthy living patterns, workplace problems, and many other such things.

The costs to our nation because of the emotional problems in the general population are enormous and worth the investment of good treatment.  Those with emotional problems hurt and some become suicidal.  People with emotional problems have an impact on their families, schools, workplace, communities, and the nation as a whole.  Most of the crime committed in our country, including white collar crime, is not committed by the SMI population.  Problems such as alcohol and drug abuse, absenteeism, workplace accidents, absenteeism, under-productivity, bad divorces that hurt children, problems in school that require resources, the judicial and penal systems, police protection, domestic violence and other forms of violence, vandalism, theft, ripping off insurance and other companies and individuals, runaway teens, child abuse, teen pregnancies, smoking and overeating to ease anxiety and depression, and families in pain that raise children who hurt and who go on to raise another generation of children who grow up in a family that hurts are more often than not, the result of the emotional problems of those who are not seriously mentally ill.

These problems cost our nation dearly and the people involved deserve care and often require long-term psychotherapy.  These people do not deserve to disparagingly or dismissively be referred to as the "worried well."  They are people in pain and we need to let policy-makers know this.  Most don't need much insurance money to get the treatment they need, but many need some, and they need some without managed care.  For our country to be a mentally and physically healthy nation, the seriously mentally ill and those with emotional problems need high quality care that will treat the causes as well as the symptoms of their problems so that all Americans may live as productively, safely, and peacefully as possible.

As I began talking about this concern at the Board meeting, there was much support for the idea of a campaign to dispel they myth of the "worried well."  Pat Dowds and Dave Byrom said that they, too, have always been distressed by this phrase.  Thus, the three of us will be working to dispel this myth.  While continuing to advocate for the seriously mentally ill and the non-SMI folks, we hope to produce a fact sheet and/or a paper to substantiate the seriousness of the problems of the non-SMI population and the costs to our nation when emotional problems go untreated.

Best regards,
Karen Shore, PhD, President

Back to Newsletter

Help to support the National Coalition by purchasing logo items from our store

Click here to view our PRIVACY policy