Shared Perspectives

More than 43 million Americans possess no health-care insurance. In addition, America lacks a "health CARE" system. Instead, we have created a hodgepodge system. We wait too long to intervene in health-care problems and do so mainly in hospitals only after the need for intervention has become acute. Only 5 percent of health dollars are spent on prevention or on early intervention.

This is an egregious state of affairs. Rather than using resources sensibly, this nation has grown the "managed care" strategy to contain health expenditures and to ration care secretly. The innovation has been an exceptionally "creative" one for entrepreneurs: It has diverted health dollars into administrative costs, upper level management salaries and investor profits for the megacorporations who now own the health-care marketplace.

Fortunately, many signs of a possible paradigm shift are appearing everywhere. Newspaper editorials, media attention, the pronouncements of policy-makers and the actions of legislators all make it clear that no one is happy with the current state of affairs.

Let's be leaders

For some time now, I have been trying to persuade APA to take up a leadership position in helping to design some much needed modifications to the nation's health-care system. I am only one of a growing group of colleagues who have spent a great deal of time studying health-care economics, model systems in other nations and the political considerations that would have to be addressed in order to produce significant change.

Three years ago, I introduced into APA Council a "new business" agenda item known as "30B." It asked the association to invite the stakeholders in health care (the other professions, significant employers, unions, consumer organizations and key policy-makers) to come together in a forum for dialogue. The aim of the effort would be to begin the design of a system of care that would 1) provide universal coverage, 2) be affordable within the American national budget, 3) shift more resources to prevention, wellness and early intervention and 4) restore needed choice and decision-making to patients and professionals alike.

I believe these objectives are coming within political reach. But they can be realized only through the exercise of some leadership. A planning process is very much needed, one that can succeed in the design of an alternative system for the nation, a sound system that can meet the needs of all the various stakeholders in health care. Only then will our country at last be able to move beyond the present managed-care plunder of human suffering for corporate profit.

My agenda item still waits for my colleagues in APA governance to decide at last that we should begin the necessary coalition building. While there has been a lot of emotional support for what I have been advocating, many of those in leadership are worried about two matters: What is it going to cost to engage in meeting expenses for such a project. Who are we psychologists to think that if we did issue invitations to concerned parties that they would take us seriously and show up?

These sources of resistance make me gnash my teeth. Think of the implications. Many have been saying that it is time for psychology to assert its claim to be a primary health-care profession. But if we are, indeed, a credible health-care profession, what is our vision for the best way that health care can be given to the citizenry? Do we have any unique contributions to make, or do we have to keep attaching ourselves to change initiatives created by others?

Shaping a vision

To avoid a confrontation with our organizational resistance, some of my colleagues and I have begun a process of education and have searched for other ways to begin coalition building until the time is more ripe for APA to move forward. Last year, I was joined by Russ Newman, Wayne Sotile, Gerald Koocher and Dorothy Cantor to respond to an invitation to help shape Bill Bradley's health-care initiatives. By the time you read this, Russ and I will also have represented APA at a health-care forum hosted by Families USA and the health insurance industry.

Nevertheless, I remain eager for our profession to do more than follow. Let us attempt to rise to a place of leadership in the health-care ranks. Both the science and profession of psychology would experience a renaissance if such a transformation could be effected. In order to do so, however, we will have to shape a vision. We can do it. Who else, after all, knows more about health behavior? Who else knows more about the problems involved in attempting to change complex systems? Who else has such a noble and important record of commitment to the public welfare?

I believe a better health-care system can be designed and that APA can lead and can begin the process. If you believe me, let your council representatives know that you support action on Item 30B. Please join me in saying that the time is now.

Arthur L. Kovacs, PhD, is founding dean emeritus of the California School of Professional Psychology, Los Angeles.