| Arthur Kovacs, Ph.D. | Taking Action on Consumer Choice
I have been trying for three years to get the American Psychological Association to take up a leadership position in helping to design some much needed modifications in the nation’s health care system. Three years ago, I introduced into APA Council a “new business” agenda item known as 30B. It still awaits the moment when my colleagues in APA governance at last decide that we should consider engaging in coalition building to get the stake holders in the nation’s health care system to the table to debate health care and to see if there is a way to create a better system that that represented by our present one. In the meantime, the American Medical Association has come to the same conclusion as did I, but its leadership has decided that the time had come for physicians to act. In the Sunday, November 14, 1999 editorial page of the Los Angeles Times, the following editorial, titled “Choices in Health Insurance” appeared: “UnitedHealth Group’s move last week to give physicians full say over patient care has been rightly hailed as good medicine, but pundits went overboard when they predicted the decision could win millions of new customers for United Health, the nation’s second-largest health insurer. “Consumer choice is limited in today’s health care market. Most Americans obtain their health insurance through private employers, and only 17% of firms offer workers a choice of two or more health plans. For most Americans, the choice is ‘take it or leave it.’” President Clinton tried to expand patient choice with his 1994 Health Security Act proposal, but the 1,342-page plan outlined a meddlesome bureaucracy that, with a blitz of insurance industry ads against it, was roundly rejected in Washington. Now, however, the influential American Medical Association has proposed a more viable plan that could achieve a similar if more modest result. “The heart of the AMA’s proposal is to give workers a federal tax credit specifically for the purchase of health care. Individuals could buy coverage through employers or through health purchasing cooperatives set up by churches, unions, trade groups and others. Currently employers subsidize tax credits: This plan cuts out the middleman, making the tax credit an explicit part of employee compensation. “It’s complicated, but essentially the choices and the money would be put under the control of the individual. Because the plan envisions spending no new federal money, it would still leave millions uninsured. But it’s a good start. “Fiddling with the tax code is usually a non starter in Washington. But the AMA - which only two months ago managed to persuade Republican legislators to buck their party leadership and endorse a far-reaching HMO reform bill - has succeeded in making the idea the centerpiece of a major summit on health care in Washington on January 13. The fact that the conference is being organized by special interests ordinarily at each other’s throats - the American Hospital Association, the American Nurses Association, the Health Insurance Association of America and the U.S. Chamber of Commerce, among others - illustrates that a consensus is building in the private sector on the need for fundamental health reform. And in a poll conducted recently by organizers of the Washington conference, 55% of respondents said they preferred using the budget surplus to provide health coverage for the uninsured over cutting federal income taxes or paying down the national debt. “Health advisors to the leading presidential candidates Al Gore, George W. Bush and Bill Bradley already agree on the basic principles embodied in the AMA proposal, namely the need to enhance consumer choice and target subsidies at vulnerable populations. At the very least, then, the candidates should join the AMA and members of the Washington summit in recognizing principles that should be the bedrock of any meaningful reform.” That was quite an editorial. Think of the implications. Many of my colleagues have been saying that it is time for psychology to assert its rightful claim to be taken seriously as a primary health care profession. But if we are, indeed, a health care profession, what is it that WE believe is the best way that health care can be given to the citizens of this nation? Do we have any unique visions, or do we have to keep attaching ourselves to change initiatives created by others? What can we add to the dialogues? Are we even an invitee to the AMA’s January 13 meeting? I have felt for some time now that the zeitgeist was becoming favorable for change to occur, or, to quote a famous line from a song, “The times they are a changing...” I yearn for the American Psychological Association to become a powerful voice and a major participant in the dialogues that can create a better care system for ourselves - not alone as professionals but even as persons who will ourselves require health care - and for our children in the century to come. We psychologists are intelligent and creative; we are not bereft of wonderful ideas. Some of our psychology colleagues have generated significant think pieces. The Interdivisional Task Force on Managed Care and Health Care Reform of Divisions 29, 39, and 42 stands ready to assist efforts to design a better future. Who is ready to join with me in saying that the time is now?
Arthur L. Kovacs, Ph.D., is a past president of Division 42 and has served as council representative and is currently member at large. He can be reached at 1821 Wilshire Blvd., Ste. 411, Santa Monica, CA 90403. E-mail: ALKOVACS@aol.com. |
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