Success in Washington

Bob Pyles's work as president of the American Psychoanalytic Association has made our officers and members more aware that psychoanalysts have to be active in the public arena in order for psychoanalysis to have a continued influence in our culture. As a result, we have been more active in public information and political action. The meetings in Washington in May 1999 were both a culmination of this social awareness and the beginning of an ongoing interaction between psychoanalysts (as individuals and as members of an active, astute, sophisticated organization) and the government and press. We have learned how to navigate the real world, despite our miniscule numbers in comparison to other mental health organizations and our small budget in contrast to the megabucks of pharmaceutical and insurance companies.

How can words communicate adequately the excitement that we felt in Washington? At the Capitol Hill breakfast forum “Preserving Privacy, Cornerstone of Quality Health Care,” when 200 of our colleagues and close to fifty Congressional staffers gathered to hear Reps. Edward Markey (D-Mass.) and Ted Strickland (D-Ohio) talk about the centrality of medical privacy? To hear Carol Hymowitz from the Wall Street Journal and Mason Essif from PBS—and, of course, our own Bob Pyles and Harvey Rich? How different is this frame of mind from that of a quarter of a century ago, when psychoanalysts were wary of speaking in public! Jane Brody from the New York Times and Jean Dietz of the Boston Globe met with the Committee on Public Information at the 1973 Fall Meeting. These prominent journalists said that an analysts opinion is of little value if the psychoanalyst refuses to be identified. Certainly in our era we actively encourage public identification, realizing that transference issues for our own patients may become more complicated.

We have learned that there are problems to confront when interacting with government agencies. On the one hand, the Health Care Financing Administration has acknowledged the centrality of Jaffee v. Redmond, and at the Executive Council meeting, Aaron Primack, director of the quality assurance component of HCFA, stated that privacy was taken very seriously by the government. On the other hand, he also said it was necessary to provide the content of sessions during an audit because of the need to establish medical necessity.

Rep. Barney Frank (D-Mass.), who received a standing ovation from the Executive Council, spoke very differently [see page 5]. He stressed that it is inappropriate to assume we cannot afford adequate health care. This push to reduce has led to the privacy problem, with the demand for identifiable information used as a way to deny care to save money, especially in the mental health arena.

It became clear during the meetings that many of our members responded to our leadership's message that they need to be educated and trained and develop their awareness on the political process. The involvement of all

our members is vital if we are to create a viable political presence in Washington. It was fortuitous that we were in Washington in 1999, when legislation on the privacy of medical records had to be passed by the 106th Congress, as mandated by the Health Insurance Portability and Accountability Act of 1996. If such legislation is not passed, Health and Human Services rules become law by default. This is the very HHS that proposed that law enforcement agencies, seeking health care fraud, could access patients' records at will without patient consent or without a court order and that has proposed a “unique health identifier.”

The American formally endorsed the Medical Information Privacy and Security Act introduced by Sens. Patrick Leahy (D-Vt.) and Edward Kennedy (D-Mass.) in the Senate (S. 573) and Representative Markey in the House (H.R. 1057).

Do these public actions help our endeavor? Prior to the Capitol Hill breakfast, Glenn Good, the unstoppable force behind that event, was approached by Rep. David Boniors (D-Mich.) health aide, who said, “I just wanted to meet you and wanted you to know that we are supportive of your effort. Call me any time.” Representative Markey agreed to come to the forum with a highly polished script and gave an enthusiastic, fiery speech. The forum had become a popular meeting in the Capitol building.

Building Bridges

We certainly are learning that “relationships, relationships, and relationships” are the three most important criteria for an effective public information and political action campaign. Deborah Peel and Glenn Good have taught us how to do this with both the executive and legislative branches. During the meeting we learned that Bob Pyles was invited to the White House conference on mental health, initiated by Tipper Gore. We continue to nurture and expand our contacts in government.

In Washington we also nurtured our media relationships and developed new contacts at National Public Radio, PBS, and cable channels. We honored Carol Hymowitz with the first American Psychoanalytic Association Award for Excellence in Journalism. We also heard a bright young energetic friend of privacy, Robert O'Harrow, Jr., of the Washington Post, speak at the Political Action Forum organized by Peel and Howard Levine.

Psychoanalysts are very smart people. However, sometimes they ought to listen to the old adage, “The person who does his own legal work has a fool for a lawyer.” We benefited greatly from the legislative expertise of Jim Pyles of PPSV and his staff, particularly Judi Buckalew, and public information consultations from Dottie Jeffries. It would be no exaggeration to say that Jeffries continues to be the heart and soul of our public information efforts. Her knowledge, enthusiasm, and ability to develop relationships with both press and political aides, so that she learns the important issues, is a wonder to observe in action. Ellen Fertig and her staff, particularly Debra Eder, Tina Faison, and Carolyn Gatto, were essential to the meetings' success. The brochure created for the Washington meeting by Jerry Beznos, in consultation with professional designers, was probably the best public brochure ever created by the American.

At the Political Action Forum, Joe Gagen stressed that seven contacts are considered necessary to make a permanent connection with a congressional office. With a number of the key players, we had exactly that: (1) the initial brochure sent; (2, 3, and 4) several phone calls discussing the possibility of personal participation in the meetings; (5) visits by the Political Action Forum; (6) attendance at the Capitol Hill Forum; and (7) follow-up letters.

Not bad for a primarily volunteer group that's new in town. They all know now that we won't go away.