Insight Matters
Winter 2005

Healthcare Post 11-02-04
By Charles Bensonhaver, M.D.

The need for healthcare reform ranked second as an issue troubling Americans just six months before the election. During the recent campaigns politicians mentioned it, but well behind Iraq, terrorism, and the economy. With a Republican victory, reforming healthcare has all but dropped out of sight.

Nonetheless it remains the elephant in the room. Dramatically-bloated overhead, forty percent of Americans uninsured or under-insured, maddening and counterproductive business practices, and costs double that of other developed nations are but a few of the issues screaming out for comprehensive reform. Will the politicians care? How should psychiatrists respond?

The opening session of the Assembly of the APA, on November 5, 2004, presented three viewpoints. The first asserted that President Bush should champion extending Medicare to everyone. The second advocated relying primarily on private pay, employing health savings accounts and universal catastrophic insurance. The third suggested a Canadian-like system of universal healthcare, but ensuring it be supplemented by a vigorous private sector.

As I see it Americans strongly agree that the time has come for us to guarantee access to everyone. We also know that it is only with government leadership that the needed systemic changes will occur. However, we do not want the government to take over the delivery of healthcare. Socialized medicine such as the British National Health Service will not happen in the U.S.A.

Also as I see it, we psychiatrists need to focus on two parochial issues. The first is non-discrimination in coverage for the treatment of psychiatric illness including substance use disorders. The second is psychiatry as good public health. With universal healthcare our services should be emphasized. Most of what we do is efficient and effective public health. The WHO and the Institute of Medicine know it. We should assert it.

Our patients and our nation urgently need comprehensive healthcare reform. Since the federal government will not soon lead, let us increase our discussions leading to greater advocacy for systemic change. Here are two excellent references giving an overview: Healthcare Meltdown, by Bob LeBow, M.D., M.P.H., and Critical Condition, by Barlett and Steele.

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