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Bringing A Halt to Mis-Managed Care |
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Professional Practice |
Mary Kilburn, Ph.D. |
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A fresh and exciting thing has developed in North Carolina politics. The North Carolina Coalition of Mental Health Professionals and Consumers, Inc. has set its sights on making this development work to the advantage of mental health patients. Fortunately, the leaders of this “development” share our enthusiasm as many of our goals and ideals overlap. What has transpired is so unlikely as to make telling it somewhat difficult. Some background is necessary to understand the main thread of this article, i.e. how a powerful Coalition has emerged with the goal of taking control of the health care system away from HMOs and insurance companies and making it again work for patients and for people who provide health care. An important victory in this regard is, as I write, already history! North Carolina is a state of extremes – our geography of mountain and coast sets the stage. We are probably best known for having been the state which repeatedly sent the arch-conservative Republican, Jesse Helms, to the Senate for a number of years. Simultaneously, we were electing the liberal Democrat, James B. Hunt as our several term governor. While you’re “go-figuring on that,” fast forward to 2003. As the NC House of Representatives was electing its Speaker, a member of one political party switched his party registration from one party to the other. This simple move split the state house straight down the middle. Since neither party had a majority, this was resolved creatively by a Bi-partisan agreement to elect co-Speakers of the House – one from each party. One of our two Speakers elected at this juncture is an optometrist, Jim Black. As such, Mr. Black had extensive experience with Blue Cross- Blue Shield of North Carolina, which was well along in the process of converting from a non-profit to a for-profit corporation. Our Insurance Department, through its Commissioner, had solicited input from the public regarding this proposed conversion. There had been many attempts from legislators to force the behind-closed doors nature of the legislative deliberations to their desired conclusions by calls to declare it a “done deal.” Blue Cross had spent 18 million dollars on conversion. Public testimony had been completed and the Insurance Commissioner was studying the materials assembled prior to issuing his ruling. The conversion seemed to be traveling along “greased wheels.” However, there were rumors that our Insurance Commissioner would not be unhappy to find solid reasons to deny the conversion. In this context, the idea for the Coalition of which I write originated with Speaker Black and leaders of the Independent Pharmacists. The group approached the political consultants who had respectively advised Jim Hunt and Jesse Helms. They made an outrageously sensible and effective proposal to them. Appealing to their non-paritsan outrage at what is happening to health care, they proposed these two join forces and with backing of the medical community, defeat the conversion of Blue Cross and stop the mis-management of health care by so-called “Managed Care!” Their reply – “You’re On.” Knowing they could not possibly match the deep pockets of the insurance industry, these strategists did a further remarkable thing which their experience had taught them to do well. Instead of giving politicians money, they gave citizens and legislators information. Information about the allocation Blue Cross was making of its huge profits. Information about what conversion had meant to health care in other states – all bad for health care. Information to legislators that they would have to take a public stand for or against conversion. They let legislators know that they were following their actions in regard to health care very carefully and would not hesitate to call these to the attention of their constituencies. The back room had a flood light cast on it. Apparently not wishing to have their application formally denied, Blue Cross summarily threw up its hands and withdrew its application to convert to a for-profit company. That “victory” was probably only temporary in that the alliance expects that Blue Cross is likely to come back and try again, but it was a dramatic and unexpected turn-around. And it has the legislators, citizens and special interests in this state paying attention to this Coalition as a powerful force. The name of this unlikely alliance is Procare. It is incorporated as a 501 c-6 – the same corporate structure that the NC Mental Health Coalition utilizes. Procare invited some of us who had been leading the struggle for mental health patients in the ” never-never land of managed care” to hear about their plans and aspirations. In our conversation, all parties concerned recognized that there was a natural “fit.” As one mental health professional and veteran Coalition leader put it, “I feel like the Cavalry has arrived!” These folks have the political know-how to accomplish what those of us schooled in the art and science of psychotherapy could only dream of. Furthermore, they recognize the value of our cause and actively solicit our ideas, vignettes and experience. The NC Coalition is struggling, as is the National Coalition. The ongoing up-hill battle has taken its toll on too many a brave soul – burnout is the norm. There was some thought that the NC Mental Health Coalition should just join Procare, dissolve our structure and be done with it. Upon deliberation, however, we decided that it would be best for us to retain our identity and feed our ideas concerning mental health into the larger Coalition, which now includes over 40 health care professions. In exchange for our public endorsement of Procare, they have offered to have one of their staff members “dedicated” to mental health concerns; we have yet to explore exactly what that means. They are actively soliciting vignettes about mental health abuses of managed care. Please share your vignettes with us for use by Procare. While a few of us continue to abound in vision, creativity, charisma and conviction, we have extremely limited resources of a tangible nature. We have no administrator – our Achilles heel. Donations of either time or money are minimal. A few committed souls continue to carry the load. We are pleased and optimistic about the possibilities we see. We are invigorated by the fact that these extremely knowledgeable people outside the field share our outrage about what is being done to mental health. It is of particular note that these veteran politicos are “head-shaking-shocked” as they become aware of the tactics the insurance companies are using to deny mental health care to policyholders. They share our conviction that the public and legislators will be similarly shocked and outraged as they get our story out to them. Please help us get that story out by sending vignettes to marykilburn@earthlink.net. We now have a proven powerful and effective use for them. |
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