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Chapter 15

The Warriors

Any account of the combat between managed care companies and community leaders is of necessity incomplete. Many unsung warriors have endeavored daily to wrestle their right to health from the entrepreneurs that are denying access to medical care.

Many advocacy groups have risen to the challenge from the very beginning. By stressing the need for excellence in diagnosis and treatment, the National Association for Research on Schizophrenia and Affective Disorders (NARSAD), the Depressive-Manic Depressive Association (DMDA), the American Anxiety Disorders Association (AADA), and several other advocacy groups have come to the very front of the battle.

The National Alliance for the Mentally Ill (NAMI) has been an ever present, ever dynamic force, probing, pulling, pushing, demanding, and never retreating. NAMI has often been a major engineer of efforts at winning seemingly impossible victories. When legislative action on parity coverage for the mentally ill first started to become a reality, three senators whose families had suffered because of mental illness carried the day. Behind them was the might of NAMI and its followers. This is one of many examples:

The National Mental Health Association (NMHA) has been a constant source of innovative health concepts, ideas for new programs, strength in the daily battles, and new strategies in the midst of changing centers of controversy. By being always in touch with the public, with legislators and with community leaders, NMHA has often managed to convert nuclei of conflict into areas of progress.

The academic community, hardest hit in several ways, has come to the front after realizing that managed care practices may destroy the country's system of medical graduate education. The reason is that since Medicare was enacted in l965, it has included support for teaching hospitals. This support, thanks to the managed care companies, is now being eroded. After 1990, growth slowed markedly in medical schools where managed care had penetrated. Much time is now being used for treating large numbers of patients for lower fees. The same time is sorely needed for education and research.

During the managed care years, private insurers have constantly reduced their payment for hospital care in university centers, in part by not paying Medicare subsidies for medical graduate education (if the Medicare patient pays through the HMO, the Medicare subsidy money for education stays with the HMO). Medicare payments have not yet followed the free fall that has occurred in payment by the private sector, so that today legislators who want to reduce Medicare payments suspect that Medicare is actually subsidizing reduced payments by the "for profit" HMOs. In other words, if HMO payments stay below cost, Medicare payments have to stay above cost in order to prevent the collapse of the teaching hospitals.

Physicians in all specialties have joined the academic groups, the community at large and an increasing number of legislators in fighting to prevent the eventual final victory of the managed care industry: closing the teaching hospitals so that the country is rendered unable to produce new physicians.

Families USA, a consumer organization based in Washington, D.C., has helped greatly in understanding the effects of managed care decisions and policies. It has published the compensation of the top 25 highest paid HMO executives for l996. The salaries of the first 10 ranged from more than 5 million to more than 29 million a year. Some of the companies were in financial trouble because of their policies.

Family Voices is a national grassroots network of more than 12,000 families and friends concerned about children with special health needs. This organization has conducted surveys that help portray the deficiencies of managed care as opposed to other systems. A recent Managed Care Survey in Atlanta, Denver, Des Moines and Seattle left no doubt that "families were twice as likely to be highly satisfied in non-managed care plans as in managed care plans with aspects of service delivery of greatest importance to children with special needs". This came as no surprise to most of those who have required medical services in the recent past.

Karen Shore, Ph.D. took the cause of our patients as her own, and has been battling the managed care hordes with ever fresh ideas and tremendous energy. We asked her how she got to a position of leadership in the anti-managed care movement.

Here is her answer:

I think that I understood the issues of power, control, and corporate 'imperialism' and the effects they would have on health care, on patients, on the professions, and on the education and training of new clinicians. I think I was sensitive to these issues because of my being a woman and a Jew who grew up right after WWII with an awareness of the Holocaust and the disempowerment of women and minorities.
I am well aware that those that love power, control, and money often try to get as much of them as they can at the expense of others, without really caring who they hurt. My first reaction when I heard about managed care was to re-read George Orwell's '1984' and Aldous Huxley's 'Brave New World', for I could see that this was a takeover of control of all health care by aggressive predators who were in it for their own financial gain and needs for power. I wrote about the similarities between the managed care industry and totalitarian regimes, and the effects of industrialization on the human psyche, gained from my interest in Erich Fromm's writings.

I also knew that the professional associations were lagging behind my thinking and were more conservative than I felt the need to be. I knew I needed to form an organization through which I and others like me could speak out without mincing words or worrying who we were going to make angry. I did make many people angry and got called a lot of bad names for the first few years. That doesn't happen anymore, though...quite the opposite now. While we were partly pushing and opposing the professional organizations at first, as they have moved into more opposition to managed care, we are now working more cooperatively with the professions.

We formed the National Coalition of Mental Health Professionals and Consumers, Inc. in November of 1992, right after Clinton, a managed care supporter, was elected. We knew we needed to be interdisciplinary and to involve consumers to be able to play a significant role. I have spent a lot of effort building the necessary liaisons, for it is the only way. With Rescue Health Care Day (RHCD), April 1, 2000, we are now building liaisons with organizations from all fields of health care, not just mental health. I knew from the beginning that a good mental health package could not exist inside a bad health care system. We need to address all of health care.

RHCD will be a day for the nation to express a vote of 'No Confidence' in managed care and corporate health care, to demand alternative systems that will bring quality and consumer freedom, and to teach and learn about the possible alternatives to managed care. Over 100 organizations support RHCD.

Our goals have been to expose, regulate and replace managed care. I knew from the beginning that managed care could not be fixed due to its inherent conflict of interest, because of greed on the part of the managed care organizations, because of their lack of concern for others, and because of their ability to control the flow of money, making patients and clinicians depend on them. Economic dependence is the way of tyrants.

We have been successful exposing the problems of managed care to the public through the media. The NY Times published, in February of l993, my letter entitled 'The Trauma of Managed Mental Health Care'. This brought us over 150 calls from all over the country and launched us into a position of visibility with the media, which had not covered mental health much before. Since then, I and members of the Coalition have been quoted in the NY Times, the Wall Street Journal, Business Week, Newsweek, and dozens of other newspapers and magazines, seen on TV (60 Minutes, Nightline, all major networks) and interviewed on numerous radio programs. I would estimate that 75% of everything that has appeared in the media about managed mental health care involved the Coalition

We have been very involved in lobbying efforts and helped our members do this task well.

I really want to change the country. I became a psychologist and a psychoanalyst because I know that there are a lot of people in pain in this nation and that many of us have the ability to heal that pain. I don't want anyone to impede my desire and ability to do that. Further, I truly want to see America be a physically and mentally/emotionally healthy nation. We can reduce violence, depression, anxiety, and many destructive acts against self, other people, families, communities, and society at large. This destruction has to do with emotional and physical pain. It is an outrage that healing pain should be twisted into a game of Monopoly for corporate executives and shareholders.

I am no longer considered a radical. My belief has been: if you think you are right and keep on saying what you believe, and - if you really are right - eventually you go from being a radical to bringing others along to being the voice of the mainstream.

Ivan Miller, Ph.D. has given extraordinary scientific support to the critics of managed care. A prolific writer, Dr. Miller has analyzed the internal flaws in managed care thinking and exposed the ethical aberrations of systems based on denial of care. He is completing an analysis of quality issues that will add much weight to our claims that managed care is a flawed and senseless idea.

Dr. Miller has also distinguished himself as a consumer advocate who has enhanced communications between professionals and patients. He is the founder and President of the Boulder Psychotherapists Guild. The Guild's Directory of Therapists offers free community presentations and operates a referral line. It is the largest and longest lasting interdisciplinary organization promoting individual responsibility for psychotherapy. Dr. Miller gives advice through the Mental Health Insurance Action Line. This service also offers The Mental Health Consumer Protection Manual: A guide to Solving Problems with Insurance and Managed Care

Dr. Miller's research has demonstrated that "evidence" supporting time-limited therapy has been mostly based on misquoted and misinformed re-evaluation of minimal data.

Bryan L. Welch, J.D., Ph.D., an excellent clinical psychologist turned into an equally excellent anti-managed care lawyer, has spent several years defending managed care victims all over the country. Testimony to his highly successful challenge is given by the companies themselves, who inevitably insist on settlement clauses that prevent disclosure of the claims and the settlement. In 1983, while practicing psychology in Chapel Hill, North Carolina, he recognized the impending damage to mental health. His writings and speeches since then were an early warning to the public about the devastating impact managed care would have on mental health services. Starting in 1985, Dr. Welch became instrumental in establishing an effective anti-managed care advocacy in the American Psychological Association. In 1994, Dr. Welch left the American Psychological Association, and established his own law firm focusing on litigation against the managed care industry on behalf of patients and doctors alike who have been victimized by managed care.

Joseph R. Sahid, a corporate lawyer with an extensive and successful background in class action suits is at the center of an effort that represents the feelings of most mental health professionals: he will demonstrate in court that nine mental health managed care companies have conspired against mental health professionals. This conspiracy has severely impaired our ability to provide adequate care to our patients. Discovery in this suit is likely to provide extensive evidence about the inner works of a nefarious plot..

Mr. Sahid is a well known litigator with nearly 30 years experience handling protracted, complex litigation. He has recently participated in some of the most difficult antitrust class action litigation taking place in the U.S

n the 1980s Mr. Sahid represented five domestic steel companies against foreign steel manufacturers, allowing them to compete more effectively.

Mr. Sahid led teams of up to 100 professionals defending IBM against antitrust charges, including those brought by competitors, the U.S. Government, and the European Economic Community.

main | table | intro| 1 | 2 | 3| 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | *

©2000 Munoz and Eist, The People v. Managed Care


main \| table \| intro\| 1 \| 2 \| 3\| 4 \| 5 \| 6 \| 7 \| 8 \| 9 \| 10 \| 11 \| 12 \| 13 \| 14 \| 15 \| 16 \| 17 \| 18 \| *

	Chapter 15 The Warriors

	Any account of the combat between managed care companies and community leaders is of necessity incomplete. Many unsung warriors have endeavored daily to wrestle their right to health from the entrepreneurs that are denying access to medical care.

	Many advocacy groups have risen to the challenge from the very beginning. By stressing the need for excellence in diagnosis and treatment, the National Association for Research on Schizophrenia and Affective Disorders (NARSAD), the Depressive-Manic Depressive Association (DMDA), the American Anxiety Disorders Association (AADA), and several other advocacy groups have come to the very front of the battle.

	The National Alliance for the Mentally Ill (NAMI) has been an ever present, ever dynamic force, probing, pulling, pushing, demanding, and never retreating. NAMI has often been a major engineer of efforts at winning seemingly impossible victories. When legislative action on parity coverage for the mentally ill first started to become a reality, three senators whose families had suffered because of mental illness carried the day. Behind them was the might of NAMI and its followers. This is one of many examples:

	The National Mental Health Association (NMHA) has been a constant source of innovative health concepts, ideas for new programs, strength in the daily battles, and new strategies in the midst of changing centers of controversy. By being always in touch with the public, with legislators and with community leaders, NMHA has often managed to convert nuclei of conflict into areas of progress.

	The academic community, hardest hit in several ways, has come to the front after realizing that managed care practices may destroy the country's system of medical graduate education. The reason is that since Medicare was enacted in l965, it has included support for teaching hospitals. This support, thanks to the managed care companies, is now being eroded. After 1990, growth slowed markedly in medical schools where managed care had penetrated. Much time is now being used for treating large numbers of patients for lower fees. The same time is sorely needed for education and research.

	During the managed care years, private insurers have constantly reduced their payment for hospital care in university centers, in part by not paying Medicare subsidies for medical graduate education (if the Medicare patient pays through the HMO, the Medicare subsidy money for education stays with the HMO). Medicare payments have not yet followed the free fall that has occurred in payment by the private sector, so that today legislators who want to reduce Medicare payments suspect that Medicare is actually subsidizing reduced payments by the "for profit" HMOs. In other words, if HMO payments stay below cost, Medicare payments have to stay above cost in order to prevent the collapse of the teaching hospitals.

	Physicians in all specialties have joined the academic groups, the community at large and an increasing number of legislators in fighting to prevent the eventual final victory of the managed care industry: closing the teaching hospitals so that the country is rendered unable to produce new physicians.

	Families USA, a consumer organization based in Washington, D.C., has helped greatly in understanding the effects of managed care decisions and policies. It has published the compensation of the top 25 highest paid HMO executives for l996. The salaries of the first 10 ranged from more than 5 million to more than 29 million a year. Some of the companies were in financial trouble because of their policies.

	Family Voices is a national grassroots network of more than 12,000 families and friends concerned about children with special health needs. This organization has conducted surveys that help portray the deficiencies of managed care as opposed to other systems. A recent Managed Care Survey in Atlanta, Denver, Des Moines and Seattle left no doubt that "families were twice as likely to be highly satisfied in non-managed care plans as in managed care plans with aspects of service delivery of greatest importance to children with special needs". This came as no surprise to most of those who have required medical services in the recent past.

	Karen Shore, Ph.D. took the cause of our patients as her own, and has been battling the managed care hordes with ever fresh ideas and tremendous energy. We asked her how she got to a position of leadership in the anti-managed care movement.

	Here is her answer: I think that I understood the issues of power, control, and corporate 'imperialism' and the effects they would have on health care, on patients, on the professions, and on the education and training of new clinicians. I think I was sensitive to these issues because of my being a woman and a Jew who grew up right after WWII with an awareness of the Holocaust and the disempowerment of women and minorities. I am well aware that those that love power, control, and money often try to get as much of them as they can at the expense of others, without really caring who they hurt. My first reaction when I heard about managed care was to re-read George Orwell's '1984' and Aldous Huxley's 'Brave New World', for I could see that this was a takeover of control of all health care by aggressive predators who were in it for their own financial gain and needs for power. I wrote about the similarities between the managed care industry and totalitarian regimes, and the effects of industrialization on the human psyche, gained from my interest in Erich Fromm's writings. I also knew that the professional associations were lagging behind my thinking and were more conservative than I felt the need to be. I knew I needed to form an organization through which I and others like me could speak out without mincing words or worrying who we were going to make angry. I did make many people angry and got called a lot of bad names for the first few years. That doesn't happen anymore, though...quite the opposite now. While we were partly pushing and opposing the professional organizations at first, as they have moved into more opposition to managed care, we are now working more cooperatively with the professions. We formed the National Coalition of Mental Health Professionals and Consumers, Inc. in November of 1992, right after Clinton, a managed care supporter, was elected. We knew we needed to be interdisciplinary and to involve consumers to be able to play a significant role. I have spent a lot of effort building the necessary liaisons, for it is the only way. With Rescue Health Care Day (RHCD), April 1, 2000, we are now building liaisons with organizations from all fields of health care, not just mental health. I knew from the beginning that a good mental health package could not exist inside a bad health care system. We need to address all of health care. RHCD will be a day for the nation to express a vote of 'No Confidence' in managed care and corporate health care, to demand alternative systems that will bring quality and consumer freedom, and to teach and learn about the possible alternatives to managed care. Over 100 organizations support RHCD. Our goals have been to expose, regulate and replace managed care. I knew from the beginning that managed care could not be fixed due to its inherent conflict of interest, because of greed on the part of the managed care organizations, because of their lack of concern for others, and because of their ability to control the flow of money, making patients and clinicians depend on them. Economic dependence is the way of tyrants. We have been successful exposing the problems of managed care to the public through the media. The NY Times published, in February of l993, my letter entitled 'The Trauma of Managed Mental Health Care'. This brought us over 150 calls from all over the country and launched us into a position of visibility with the media, which had not covered mental health much before. Since then, I and members of the Coalition have been quoted in the NY Times, the Wall Street Journal, Business Week, Newsweek, and dozens of other newspapers and magazines, seen on TV (60 Minutes, Nightline, all major networks) and interviewed on numerous radio programs. I would estimate that 75% of everything that has appeared in the media about managed mental health care involved the Coalition We have been very involved in lobbying efforts and helped our members do this task well. I really want to change the country. I became a psychologist and a psychoanalyst because I know that there are a lot of people in pain in this nation and that many of us have the ability to heal that pain. I don't want anyone to impede my desire and ability to do that. Further, I truly want to see America be a physically and mentally/emotionally healthy nation. We can reduce violence, depression, anxiety, and many destructive acts against self, other people, families, communities, and society at large. This destruction has to do with emotional and physical pain. It is an outrage that healing pain should be twisted into a game of Monopoly for corporate executives and shareholders. I am no longer considered a radical. My belief has been: if you think you are right and keep on saying what you believe, and - if you really are right - eventually you go from being a radical to bringing others along to being the voice of the mainstream.

	Ivan Miller, Ph.D. has given extraordinary scientific support to the critics of managed care. A prolific writer, Dr. Miller has analyzed the internal flaws in managed care thinking and exposed the ethical aberrations of systems based on denial of care. He is completing an analysis of quality issues that will add much weight to our claims that managed care is a flawed and senseless idea.

	Dr. Miller has also distinguished himself as a consumer advocate who has enhanced communications between professionals and patients. He is the founder and President of the Boulder Psychotherapists Guild. The Guild's Directory of Therapists offers free community presentations and operates a referral line. It is the largest and longest lasting interdisciplinary organization promoting individual responsibility for psychotherapy. Dr. Miller gives advice through the Mental Health Insurance Action Line. This service also offers The Mental Health Consumer Protection Manual: A guide to Solving Problems with Insurance and Managed Care

	Dr. Miller's research has demonstrated that "evidence" supporting time-limited therapy has been mostly based on misquoted and misinformed re-evaluation of minimal data.

	Bryan L. Welch, J.D., Ph.D., an excellent clinical psychologist turned into an equally excellent anti-managed care lawyer, has spent several years defending managed care victims all over the country. Testimony to his highly successful challenge is given by the companies themselves, who inevitably insist on settlement clauses that prevent disclosure of the claims and the settlement. In 1983, while practicing psychology in Chapel Hill, North Carolina, he recognized the impending damage to mental health. His writings and speeches since then were an early warning to the public about the devastating impact managed care would have on mental health services. Starting in 1985, Dr. Welch became instrumental in establishing an effective anti-managed care advocacy in the American Psychological Association. In 1994, Dr. Welch left the American Psychological Association, and established his own law firm focusing on litigation against the managed care industry on behalf of patients and doctors alike who have been victimized by managed care.

	Joseph R. Sahid, a corporate lawyer with an extensive and successful background in class action suits is at the center of an effort that represents the feelings of most mental health professionals: he will demonstrate in court that nine mental health managed care companies have conspired against mental health professionals. This conspiracy has severely impaired our ability to provide adequate care to our patients. Discovery in this suit is likely to provide extensive evidence about the inner works of a nefarious plot..

	Mr. Sahid is a well known litigator with nearly 30 years experience handling protracted, complex litigation. He has recently participated in some of the most difficult antitrust class action litigation taking place in the U.S

	n the 1980s Mr. Sahid represented five domestic steel companies against foreign steel manufacturers, allowing them to compete more effectively.

	Mr. Sahid led teams of up to 100 professionals defending IBM against antitrust charges, including those brought by competitors, the U.S. Government, and the European Economic Community.