American Board of Psychological Specialties

By
Ronald Hixson, Ph.D.


We all read sign posts and benchmarks of a future destination. We can read maps and have the ability to ask questions. At one time, television consisted of three channels of black and white that signed off at ten or eleven each evening. Now newscasts are broadcast globally, and some run 24-7. Satellites carry stations that were once lost when driving from one city or state to another. Heavy boxes no longer bring pictures to us as events occur around the world. We now have cell phones, iPods, Blackberries, pagers, car radios, televisions, and Internet websites that can provide us with information as well as entertainment. Access has increased and we, as a society, have benefited. The cost of many of the instruments of information has decreased as new ones are introduced. There is a thirst for immediate access to information. We are in the fast lane to the future, and we want to know what is going on and how we will be affected.

The banking and manufacturing industries have been hit hard by changes. Mortgage firms and the real estate industry have imploded.  A few months ago, the oil industry was torturing us with outrageous prices. Today, we face difficult questions:  can we afford the amount of health and life insurance we need? Are we going to lose our jobs? Will we have to move? The educational industry is under fire for placing stress on our children in an effort to “get better results.” The educational process has grown from a one-room school on the prairie to a multi-acre and multi-million dollar business in many communities. At one time, students in graduate schools were young and fresh out of undergraduate school. Today, there are more people returning to school after long absences for graduate degrees. In the past, graduate schools kept one discipline separate from another. Today, we see inter-disciplinary programs. Not long ago, mental health therapy and physical health medicine were taught and practiced separately. Today, medical schools are opening up to the need of more doctor-patient communication and the power of the mind in the healing practice.

Over the years, on two continents and within different cultural communities, I have treated cases of anxiety, panic, depression, and thought disorders. At one time, people never shared their experiences with a psychotherapist; now it is common practice in many larger cities. As we change, our lifestyles will have changing needs. Many of these needs include social and relationship problems. Americans are witnessing a larger growth in divorce, attachment-detachment issues, attention problems, paranoia, and autism. While smoking may be decreasing, there are reports that adults and adolescents are turning to medications to replace illegal drugs in order to cope with the many stresses of life.
The Achilles’ heel of health care consists of:  high costs, uneven quality and quantity, a fragmented communication system between providers of health care and insurance giants, a lack of appreciation from patients for the problems of their providers, and a lack of active participation of providers in developing best-practice standards.  In his book, Rx for Health Care Reform, Ken Terry (2007) explains the problems associated with the health care industry:

“Providers are paid for services on a piecework basis, creating incentives for them to generate patient demands for services and not to invest in developing the systems to treat patients efficiently. Providers advertise the latest medical technologies directly to consumers, who in turn demand more services paid for by a third party. Neither consumers nor regulators have adequate tools to measure the quality of care, so providers are under little pressure to improve.”

Restructuring the health care system will require us to redefine how we practice health care and how it is financed and administered. Porter and Teisberg (2006) would agree with Terry in that cost and access are critical elements of the health care industry that need to be evaluated.  They add to Terry’s list the responsibility of the consumer:

Competition in the current system is also too narrow, a seemingly paradoxical result. The reason is that competition takes place on discrete interventions rather than the full cycle of care where value is determined. Value can only be measured over the care cycle, not for an individual procedure, service, office visit, or test. Nobody takes an overall care-cycle perspective, including steps to avoid the need for intervention (prevention) and ongoing management of medical conditions to forestall recurrence (disease management). (Porter and Teisberg, 2006, p. 4).

Ivan J. Miller is a psychotherapist in Boulder, Colorado, where he is active in organizing support groups of therapists as well as maintaining a private practice. His book discusses how Balanced Choice is a health care system that offers two plans:  “one that offers benefits similar to a single payer system; and the other, based on market principles, that offers more choices of providers. When balanced together, they provide a comprehensive, universal coverage health care security system in which both consumers and providers have freedom of choice” (Miller, 2006, p. 4). According to Miller, the present system causes dysfunction by (1) having a captive group of consumers who are not free to change insurance companies, (2) controlling the captive group’s choices and (3) profiting when quality and access are decreased. The result is that in the insurance-driven, managed-care health care system, the quality of health care and access to health care are damaged in order to provide profit to managed care entities” (personal communication, December 16, 2008).

David Cutler takes a similar approach to Porter and Teisburg in that he stresses the value of health care and the extension of life services.  As an economist, he promotes the economic value that additional life and good health can bring to a community and the nation:
The goal of medical care is to improve our health. The system works well if it improves health sufficiently to justify its cost, and poorly if it does not. That seems obvious, but it has deep implications. Most significantly, it implies that controlling medical costs is not an important goal in itself. Lowering costs is good if we are overspending, but bad if we are getting valuable care. Because so many people do not get care when they need it, we could spend more on those people with excellent results. We worry far too much about wasting money on medicine. (Cutler, 2004, p. xii)

Regina Herzlinger argues, with her nationally-acclaimed book Market-Driven Health Care in 1997, that, “health care should resemble other retail markets, where unleashing consumer choice results in competition and innovations that improve value” (as cited in Galvin, abstract). Herzlinger has written another book: Who Killed Health Care? America’s $2 Trillion Medical Problem and the Consumer-Driven Cure. In it she points a finger at the motives and methods of those in the insurance community, hospital corporations, governmental agencies, and academic sectors for crippling the health care system. “A system controlled by the insurance companies or hospitals or government will kill us financially and medically—it will ruin our economy, deny us the health care services we need, and undermine the important genomic research that can fundamentally improve the practice of medicine and control its costs” (Herzlinger, 2007, p. 1). Only one group can stand in the way of this destruction and turn it around—the consumers working in conjunction with primary care physicians.

We have practiced our crafts for years, invested loads of time and money to hone our skills, and now many feel that we are losing our practices to large corporations and even more governmental regulations. It has been people like Sigmund Freud, Carl Rodgers, Peggy Papp, Evangeline Munns, B. F. Skinner, Albert Bandura, R. D. Laing, Milton Erickson, Albert Ellis, and William Glasser who have created knowledge, built benchmarks, and challenged therapists of all disciplines to put the patient first. These professionals have left volumes of material that has benefited our field of practice. But is it enough for tomorrow’s practice? We have new benchmarks, new sources of information, and new challenges in our industry. We have the freedom and the obligation, and we must have the professional integrity to stand up and ask questions and to offer our constructive ideas and solutions. The future is now.

References:
Adler, M. J. (1982). The paideia proposal. New York: Macmillan. Retrieved from http://radicalacademy.com/adlerfreedomthrudiscipline.htm
Cutler, D. (2004). Your money or your life, strong medicine for America’s health care system. Oxford: Oxford University Press.
Dewey, J. (1907). The school and social progress. In The school and society (pp. 19–44). Chicago: University of Chicago Press. Retrieved from http://gayleturner.net/Dewey%20School_Social%20Progress.pdf
Greene, M. (1988). Freedom, education, and public spaces. In The dialectic of freedom (pp. 1–23). New York: Teachers College Press.
Galvin, R. (2007). Consumerism and controversy: A conversation with Regina Herzlinger. Health Affairs; 26 (5). w552-w559.
Herzlinger, R. (2007). Who killed health care? America’s $2 trillion medical problem—and the consumer—driven cure. New York: McGraw-Hill.
Miller, I. (2006). Balanced choice, a common sense cure for the U.S. health car systems. Bloomington: AuthorHouse.
Porter, M.E., & Teisberg, E. O. (2006). Redefining health care, creating value-based competition on results. Boston: Harvard Business School Press.
Terry, K., (2007). Rx for health care reform. Nashville: Vanderbilt University Press.