Health-care reform

Regarding Russ Newman's column "Moving beyond reform" in the May Monitor, we certainly agree that good mental health care means integrating mental and physical health, concentrating on prevention and teaching behavioral change for health promotion. But it is very clear to us that these things cannot be accomplished in the current fragmented, privatized health-care system. To preserve and expand the professional work psychologists do, we need a health-care system that will cover everyone.

Unfortunately Newman's interpretation of the phrase "moving beyond reform" seems to mean that psychologists should find ways to do psychological work outside of the health-care system. This sounds to us like not moving beyond reform, but avoiding the problem. While finding new areas to do our work may be the way to go for some psychologists, it is decidedly not what our profession as a whole needs. We would like to see the Practice Directorate support psychologists who want to continue to provide psychotherapy in their private practices. The best way to do this is to join with other national organizations in working to replace the current health-care system with one that provides health care for all-i.e., a single payer system, such as traditional Medicare, with no managed care.

Psychologists need to stand up for access, affordability and universal inclusiveness in health care, not only for the sake of our patients and our society, but for the preservation of the work that we do.

Marianne Jackson, PhD
Brooklyn, N .Y.


Helping psychologists make unique contributions outside the health care system should not be in place of working within it, rather in addition to it. Additional opportunities for practitioners are particularly important now, when a badly broken health-care system makes reliance on third-party payment problematic. And because of the severity of the system's difficulties, transforming health care in this country, more than just reforming it, must be a priority for Congress. The Practice Directorate works in coalition with many other national organizations in an effort to convince Congress of this.

It is not yet clear, however, how Congress will attempt to tackle the problem, or which legislative approach will have the greatest chance of accomplishing the goals of increased access, affordability and universal coverage. Therefore, it is critical that psychology focus its efforts on assuring psychological services are included and valued, irrespective of what approach Congress pursues. To prematurely commit to one particular model or ideology runs the risk of marginalizing our voice in the many different discussions and debates that will inevitably occur on the way to successful congressional action.

In the meantime, the Practice Directorate continues to confront those obstacles that interfere with the successful practice of psychology. We are working closely with state psychological associations to take action on rate cuts by managed care plans. We are developing strategies and materials for individual psychologists to use in dealing with third-party payers. We have successfully sued major managed care companies and won victories for patients and psychologists. We helped stop a five percent Medicare rate cut slated for 2007 and are continuing to work to get Congress to roll back the nine percent cut initiated by CMS. And we have played a key role in advancing a full mental health insurance parity bill that we are optimistic will pass this year.

While these actions alone will not fix the broken health care system, they can provide help for psychologists doing psychotherapy in their private practices, as well as in the public sector.

Russ Newman, PhD, JD
APA Executive Director for Professional Practice

As a Massachusetts-based APA member, I am distressed that the Monitor has joined the hype about our state's new "universal" health insurance law. This bill is, in fact, a cruel hoax that, if emulated in California and elsewhere, will turn the clock way back on efforts to provide American citizens with universal access to comprehensive, affordable, quality care. The United Nations, after all, has declared health care as an inalienable human right, recognized as such by every other industrialized nation in the world.

The fundamental premise of the law is that health insurance is an obligation of each individual, who is to be punished if he or she does not buy it. Never mind that thirty-somethings earning under $40,000 annually would wind up paying 20 percent of their before-taxes income on a plan that won't cover all health needs, can "cherry pick" healthy people without pre-existing conditions (or even bad DNA) and declare as medically unnecessary whatever the corporate bottom-line needs to exclude (e.g., intensive psychotherapy or certain preventive measures). The greater good is here defined as the runaway profits of insurance and psychopharmacology giants, whose immense lobbying power has for years defeated attempts to change our broken health-care system to the just and cost-effective models practiced by the rest of the civilized world.

It is troubling to see psychologists, who should understand the dynamics involved, fail to denounce the "victim blaming" that goes into the individual mandate plans. Sadder still to see our state and national organizations ignore the fight for a truly progressive health coverage system while focusing on narrow guild interests. As health care goes, so goes our entire profession.

Abram Chipman, PhD
Brookline, Mass.

Navigation neurons

In addition to the hippocampal cells that respond to spatial attributes described by Rachel Adelson in "Checking the coordinates" (March Monitor), neural and physiological concomitants of spatial perception on a more macro scale have been studied in human volunteers. Take, for example, the eye movements by which we scan a scene and capture visual snapshots that are connected to form a percept of the spatial environment. Although these saccades are triggered in frontal cerebral cortex and subcortical sites, they can be noninvasively recorded during complex visual and spatial tasks.

In clinical neurology, effects on visual and spatial attention have long been linked to neural damage in the parietal lobe. And in functional brain imaging by fMRI, visual attention has been associated with activation of frontal, parietal and striatal areas of the cerebrum. Brain imaging combined with a neuropsychological task suggests that a subgroup of children with attention-deficit hyperactivity disorder may have a subtle deficit in visual attention that may correspond with changes in activity in the opposite side of the brain. Such studies in human cognitive neuroscience provide a vital link to spatial cognition in clinical and applied psychology.

Robert Lavine, PhD
Washington, D.C.