Insight Matters
Spring, 2004

APA favors Universal Health Care
by Charles Bensonhaver, M.D., APA Representative (2001-2004)

At its March meeting the Board of Trustees of the APA passed its first policy in favor of access for all Americans to Universal Health Care. This effort originated in Ohio fifteen months previously. The Assembly unanimously adopted a policy statement in May of 2003. Subsequently, the matter has winded its way through APA committees ending in the Board action.

It is important that the APA has established this policy for at least two reasons, the moral imperative and the likelihood that we and our patients will be more fairly treated. A major storm compelling Americans to comprehensively reform our health care system cannot be far away. The APA as the largest and most important psychiatric professional association in America has taken a position!

We pay more per capita on health care than any nation and fifty percent more than the next most costly, Switzerland. Public health, prevention, and early detection are flagging. Rising numbers, now more than 43 million Americans are uninsured and many millions in addition are underinsured. Overhead consumes more than 25% of health care dollars. Duplication of tests and unnecessary treatment consume at least another 25%. Pharmacy costs can be quite high. Medical advances and the aging population will stress the system immediately ahead. Comprehensive reform appears inevitable.

Because of powerful vested interests, change will be difficult and traumatic. Our APA policy steers clear of some of the more charged issues such as a large government take over of health care and/or a single payer system. We simply say that the reform must enfranchise all Americans and there must be non-discrimination for the treatment of mental illness and substance use disorders.

Through the APA's Council on Public Policy and in particular its Work-group on Access to Universal Health Care additional elements to our policy will be developed and may be also adopted. They fall into two groups. First, there are the generic issues applicable to all of health care. Some of those are affordability for citizens and society; an increased emphasis on public health, prevention, and early detection; simplification and reduction of administration; systemic changes to reduce medical errors; malpractice reform; and the increased use of information technology to reduce duplication.
The second group has specifically to do with the treatment of mental illness and substance use disorders. The Institute of Medicine and the World Health Organization have data to support "parity plus" in any new system of health care. As such, society would get a disproportionate amount of "bang for the buck" if health education, screening, and active treatment for the great bulk of the illnesses we treat were emphasized, not just given equal status. I believe we should work that viewpoint into our policy. The Workgroup on Universal Access to Health Care will likely agree.

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