In Washington, D.C., there is a dramatic statue few visitors to the capital ever see. It is at the extreme end of East Potomac Park, far from the usual attractions — and, incidentally, at the twenty-mile mark of the Marine Corps Marathon. It is called “The Awakening.”
It is a representation of a heroic, monumental human figure struggling to free himself from the confines of the earth that has covered him. The arms and legs have become visible, each muscle tautly defined. The head is now free, face contorted with effort, eyes fixed on the horizon.
This wonderful sculpture serves well as a metaphor for how our Association has begun to transform itself in the last few years.
Some might wonder about the appropriateness of comparing our Association to such a powerful figure. It is difficult for us, preoccupied as we tend to be with the problems and vicissitudes of our internal issues, to appreciate how large and formidable we appear to other analytic groups. In fact, we are the only analytic organization in the United States with the organizational structure to effect serious and major change in psychoanalytic practice and public policy at both state and federal levels. We also know that, in fact, we have already had significant achievements in both these areas. It is our responsibility to work not only for the good of our own Association but for the good of all psychoanalysis. I would like to talk to you about what we have already done and what we intend to accomplish in the next two years.
Our major challenge is an internal one: to break the bonds of the way we have viewed ourselves in the past and to understand that community and political activism must become an integral part of our psychoanalytic responsibility and identity. We must become certain not only that we must do this, but also that we can do this. We would do well to keep in mind the words of Margaret Mead: “Never doubt that a small group of determined people can change the world. Indeed, it is the only thing that ever has.”
For us, the awakening began in the fall of 1993 with the announcement of the President's “Health Security Act.” As you know, this act would have made private practice a felony. This, and other similarly draconian bills that followed, made it clear that we could no longer depend upon the sanctuary of private practice to protect our patients and our profession.
We have fought back. We began as an early and lonely voice warning Congress and the public about the dangers of the Clinton plan and managed care. Gradually many other groups joined us. By the time the Clinton plan was defeated, we had established the right to private practice in every congressional bill extant at that time.
Though the direct threat to private practice has receded, the struggle to establish complete corporate control of health care delivery in this country has moved on to a series of pitched battles around specific crucial areas — most notably, confidentiality. The danger to psychoanalysis and psychodynamic therapy represented by the proposed erosions to confidentiality cannot be overestimated. Many bills currently before Congress simply define away any right to privacy. Some of these bills redefine “confidentiality” as what happens to the information once it is received by the insurance company. Any need to obtain patient consent for release of information is abrogated.
These bills pose threats not only because of the erosion of personal liberties contained within them, but also because of the tactics employed in trying to enact them. Because the public generally finds it difficult to believe that basic rights could be so easily negated, the effort is often to pass legislation very quickly before a real assessment can be made. Consider for instance the Republican-sponsored “Patient Bill of Rights,” which passed before nearly any congressman had read it. Obviously, our tactic becomes one of working with our allies to delay passage until the public and Congress can be educated as to the hidden implications of such bills.
We need to be very clear that private practice has ceased to be a safe haven. The issue here is not one of insurance dollars; the ultimate goal of many of these economic and corporate interests is to control all health care. We can be sure that the intrusive measures contained in most of these bills, if they are allowed to pass, will soon apply to private practice as well. In Maryland, a bill requiring mandatory reporting of each “clinical encounter” for all health-care providers was quietly and quickly passed. Only vigilance and determined effort by the mental health community has prevented it from being put into effect.
While there are many worthwhile healthcare goals we can support, our major effort must concentrate on the specific areas that are absolutely crucial for our profession and in which we can take a leadership position — as we have with the private contracting battle. Confidentiality should be the number one priority for our coalition in the coming year. The confidentiality issue will be coming to a head during this legislative session. In all likelihood, a bill will be passed. Bills by senators Robert Bennett (R-Utah) and Patrick Leahy (D-Vt.) and Rep. Jim McDermott (D-Wash.), and the so-called “patient protection acts” by both Republicans and Democrats, are all on the table.
Perhaps most dangerous are the Health and Human Services “Administrative Simplification” regulations, which include the “unique health identifying number” (known by some as the “national tattoo”). This would enable the creation of a huge centralized databank, with complete birth-to-death medical records on every American. These records would be used in a wide variety of ways, all completely without patient consent. The alliance between The American Psychoanalytic Association and the Coalition for Patients Rights (CPR) is uniquely placed to play a leading role in this struggle and to continue to be seen by other professional groups and the public as a leader in health-care advocacy.
We have established many new and effective committees designed to reach out to our communities and colleagues. Our public information and public education effort, under Leon Hoffman and his committee, has expanded exponentially. We are learning to work effectively with the media. This is a beginning, and a good one.
Led by Warren Procci and Sam Rubin, the coalition between our Committee on Government Relations and Insurance (CGRI) and the CPR is working well. Powerful economic and political forces are arrayed against us.
This should not make us feel overwhelmed and helpless. Rather, we have to use our resources effectively, efficiently, and assertively. I have been extremely impressed by how articulate and persuasive psychoanalysts have become in influencing political leaders. The goals passed by the Executive Council and the CPR in 1994 have proved prescient and remain our most critical priorities. However, we need to develop a strategic plan as a blueprint to maximize and guide our efforts. I hope all of you will work with me to develop and implement this plan, much of which is already under way.
The role of CGRI/CPR, acting with the advice of our legislative consultants from the health law firm of Powers, Pyles, Sutter, & Verville, is to quarterback our efforts and to gather and distribute information to our members and societies. CGRI/CPR held its first Washington meeting this past March and will continue to meet twice a year. A subcommittee under Howard Levine is helping to develop legislative action groups in as many societies as possible. Each group needs to designate a point person or small committee for this purpose. A rapid communications network is a critical step in developing our capabilities. We will be setting up an e-mail network among our national and local committees and members.
Congressional districts are organized by zip code. We are setting up a database to match the zip codes of our members to those of their congressional representatives. Once this system is in place, Powers, Pyles, Sutter, & Verville can advise CGRI/CPR when a piece of legislation critical to our interests is being heard, who the congressional and senatorial key players are, and when they should be contacted for optimal effect — often a vital consideration. Even ten or fifteen constituents contacting their congressmen via fax, telephone, or e-mail at a crucial time can have a surprising effect. John MacLeod of Cincinnati organized such an effort, which virtually shut down his congressman's office, much to our benefit, as the congressman agreed to support our position.
CGRI/CPR will develop key talking points on each issue and bill. As we build our network, it will be important for members and societies to give feedback to CGRI/CPR on contacts made and results achieved. Informational mailings will be sent to all members at least four times a year, and frequent updates will appear on the members list. Periodically, fundraising requests will be included. Our line-item budget of $48,000 will not support the effort we must make. Members responded well to our last appeal for funds: 230 members contributed $31,000. This is slightly less than 10 percent of our total number. Imagine what we could do if we could raise the contributing percentage to 80 percent!
The theme of our May meeting in Washington will be “Our Political Awakening.” We hope to have a number of notable political leaders participating in talks and panels. Presidential Awards and other special awards will be given to recognize the efforts of political and community leaders who have been helpful in preserving high-quality, confidential health care, particularly as it relates to psychoanalysis. In our December meeting in New York, Rep. Barney Frank (D-Mass.) will participate in our public forum, “Homophobia: Analysis of a ‘Permissible’ Prejudice” [see page 2]. This will be the first time a notable political figure has participated in our Association meetings.
Strengthening our affiliations and liaisons with other professional organizations is a powerful way to magnify the effect of our own Association. For example, the American Psychiatric Association has a sizable staff and a very large budget available for political action. A new APsaA Committee on Liaison, chaired by Barbara Rosenfeld, has already succeeded in establishing a greatly improved relationship with the APA and with other groups. Many members of The American have recently been appointed by APA President Rod Munoz to important APA committees. These include Warren Procci, Deborah Peel, and me, all appointed to the Joint Committee on Government Relations. We have been very successful in representing the agenda of The American in these committees.
We are also establishing a network to coordinate our political efforts with such highly successful advocacy groups as the National Coalition of Mental Health Professionals and Consumers, ably led by Karen Shore. Our work with the political action committees of the Psychoanalytic Consortium and the Independent Psychoanalytic Societies is beginning.
I urge each of you to join in this effort. Please work with your society to develop a political action group to work within your state and with all of us at the national level. Please contribute with your energy, talents, your creativity, and your funds.
It is my hope and vision that these next two years will see our Association and our societies transformed into potent political forces. I hope the day will come in the not-so-distant future when the enemies of psychoanalysis will look back at this time of transformation in our Association and echo the words of Admiral Nagumo when he was steaming away from Pearl Harbor and being congratulated for his victory. Knowing he had missed the U.S. carriers, he said, “I fear that all we have accomplished is to awaken a sleeping giant and fill him with a terrible resolve.”