When the Clinton Health Plan, with all its attendant dangers for our profession, was announced in the summer of 1993, no one could possibly have been more naïve about the way politics operated on Capitol Hill than I was. In one of our first encounters, my brother, Jim (our lobbyist) and I visited the office of Sen. Edward Kennedy (D-Mass.). One of his aides explained to us that private practice was actually unethical, because no one should be able to buy better health care simply because they could afford it. All citizens, she continued, must receive the same level of health care. Startled, I blurted out that I only knew of one group of countries where that was the case — the communist countries, where indeed health care was at the same level for everyone, and it was all bad.
Outside Kennedy's office, Jim regarded me with a pitying look. I recognized that look. It was the way our father used to look at us when he was saying to himself, “Oh Lord, why must I deal with such idiots.” Choosing his words carefully, Jim said, “Bob, I know you're my older brother, but liberal Democratic senators don't like being called Communists.”
Jim's way of initiating analysts into the vicissitudes of meeting with congressional representatives also deserves comment. After describing the way to approach a particular congressman, Jim would give the following lecture: “When you meet with Congressman X, please keep in mind that it doesn't matter if you have a good idea. It doesn't matter if you're right. It doesn't even matter if it's good for people. What matters is how can you help this person get re-elected.” The first several times I heard this, I was stunned by the apparent cynicism. But then I began to think, “What he is actually saying is that this representative has to figure out how to please his constituents. Although I would prefer more principle, maybe that's not so bad.”
I began to learn an important lesson, one that at this point has been learned by many of our analytic colleagues. Politics, like psychoanalysis, is not necessarily intuitive. Also like psychoanalysis, it doesn't have to be that hard. Once one grasps the principles of how it works, the rational nature of psychoanalytic training makes it relatively easy to shift into the political arena. As we have seen, once psychoanalysts grasp the basic premises of the political process, they can become very skilled at it.
As many of us are learning, protecting our patients and our profession from the dark forces that threaten health care is not only possible, but also a deeply satisfying experience. From those early beginnings, the American is now having an impact far out of proportion to our numbers. The more of us that participate, the greater that impact will be.
We have come a very long way since then in our political sophistication. Most recently, our Association has been a major factor in influencing the health data regulations promulgated by the Department of Health and Human Services and announced by President Clinton just before he left office [see page 1].
There are a variety of ways to get involved. Voluntary monetary contributions are the lifeblood of our effort, as APsaAs budget can only provide a fraction of the funds we need. Each society is developing a political action group to work with Howard Levine's Subcommittee on Local Health Care Initiatives. It is also essential that every society have a public information committee. Political training will be offered once again at the December meeting. Finally, any interested member or candidate may contact Howard Levine, Deborah Peel, or me.
Bob Pyles, M.D., is the immediate past president of the APsaA, a founder of the Coalition for Patient Rights, and current chair of the Committee on Government Relations and Insurance. This is his regular column for TAP on politics and public policy.