President's Message

The changes to our nation’s health care system and the rise of managed care over the past 15 years has been about many things: saving money for patients, the government and employers (primarily the latter), breaking free of the indifference to rising medical costs that characterized most indemnity insured patients, making patients more responsible for managing their own health, and so on. But one aspect of what the change is about is seldom mentioned; the massive redistribution of wealth from health care providers to corporations and their executives. They have reached into our pockets and taken a lot of hard cash for themselves in quantities that are unseemly, unnecessary and more than a little shady without enhancing our nation’s health or the public good. In any event, they have our money and we need to figure out how to stop the bleeding and get some of it back.

Before going further, let me say that I do recognize that major change was needed in the old health care system. It was way too expensive, a major catastrophe on its way to happening. Something needed to be done. The government, unable to come to agreement on a system acceptable to the myriad competing interests and pressures, allowed one group, employers, to adapt a system to save themselves money that seemed like a good idea to them at the time, managed care. At first it appeared to save money. Some of its goals made sense and nobody worried if some “rich” doctors made a little less. It took a few years for the public to understand that the new system was seriously flawed and actually worse than what it replaced.

Managed care has now become a national joke. Colleagues who proclaim, “managed care is here to stay,” may find a role for themselves in the documentary that Michael Moore is said to be contemplating on the subject, but otherwise they just appear ridiculous. No serious observer of the heath care scene now believes that managed care is here to stay. The system is imploding. Many companies are no longer making the exorbitant profits of the past. The money savings that were originally noted are not happening, patient complaints are soaring, and incredible reports of denied claims by managed care firm that have led to tragic disasters for patients are a regular part of the evening news.

We desperately need a new health care system and it is more than clear that managed care ain’t it. What will take its place is not yet obvious. Regardless of what system actually gets established, one of our aims is clear. We need to do all we can to protect our incomes from additional erosion that may well force us all out of business, and we need to work hard and creatively to recoup the losses we have already sustained. Let me be clear that I fully support efforts to protect and advance the public interest in a fair and equitable health care system. I also support a fair and equitable reimbursement rate for our services. The two are not contradictory. In fact, most of the cost estimates I have seen show that the additional costs of such payments for psychological services are minuscule. We are not the problem. We just got slammed hard for the excesses in the old system. We need to work hard, deliberately and wisely to prevent that state of affairs from continuing and being carried forward.

At its retreat meeting, the Division 42 Board of directors identified the major needs of its members. The number one issue, by a wide margin, was doing something to enhance and protect practitioner incomes. I have appointed a special presidential Task Force on Protecting and Enhancing Practitioner Incomes with Tommy Stigall as chair and a blue ribbon panel of division members: Glen Ally, Linda Campbell, Stanley Graham, Sally Horwatt, Robert Resnick, and Melba Vasquez. They held their first meeting in Honolulu at the convention and began exploring some exciting ideas of actions the division might take to address this issue in a significant and noticeable manner. They anticipate bringing a priority list of specific activities and actions to the Board of Directors, and perhaps the membership, before the year is out. Division 42 is the largest group of independent practitioners in APA and probably in the nation. We should be able to make a difference if we focus our resources and make a determined effort.

We are talking about our money, what happened to it and how to get it back. If you have creative ideas about what actions we might take, let me know. I will see to it that they are passed along to the Task Force. This is one Task Force about which I am truly excited.

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