A few words by Edward T. Gluckmann, Co-founder and Board Member
Every time I read or see a media report about some aspect of the health crisis in America, I am reminded of Groucho Marx and Yogi Berra; two skilled practitioners of the art of saying something important correctly in a few words when all the political hacks, talking heads, consultants, experts and even today’s acknowledged leaders in medical care, economics and related areas say it wrong in volumes. Groucho and Yogi got it correct while most of the others just keep getting it wrong!
It was that way with Don and I. We knew each other’s thinking and we knew what was wrong and what to do to fix it. But there are forces greater than the energetic two minds we could muster. So we reached out to others and during some twenty years CCAHS was able to right a few wrongs. It was a hell of a ride and to Don and the others who made CCAHS a reality, I say thanks.
In the early 1970’s there were many mass movements to correct the injustices in America. Most of those wrongs were maintained based on a society conditioned to not question what they were told by their leaders and silenced when they asked. Silence was the name of the game. Silence is natural when you don’t know what to ask or say. But African-Americans, women, and gays, and other marginalized groups were no longer having it; they would no longer be silenced. Their experiences informed them.
The unconscionable war in the rim of Asia had caused a tear in the social fabric. That tear was not going to be mended by more silence or lies. It splintered America into the shards of 200 or so years of lies about Native Americans, the condition of people of color, the discrimination against women, the abuse of gays and lesbians, the rational for so many unjustified wars….
And those movements while overwhelming the struggle to change a system in place to provide medical care also helped midwife the “health consumer” movement into being. Health consumers were not informed by their encounters with the health system. Health consumers were told what to do or what would be done to them. Information they were told was private and above their ability to understand. Without information, they literally went to their deaths as silenced lambs.
Morrisania Hospital-The Start; But Not the Finish
In the early 1970’s, Don and I were approached to do something about a plan to give or sell hospitals owned by the City of New York to private non-profit sector health organizations. The tipping point was Morrisania Hospital. Our involvement seemed natural as we had been intensely involved in developing a consumer movement at the Health Insurance Plan of Greater New York (HIP). That movement was created as HIP was faced with imminent financial collapse. HIP was the major medical insurer of the City’s 900,000 employees and their families. Crisis and struggle are the parents of creation and solution.
Don and I came from different backgrounds and were also separated by a decade in age. But we had talents which were complimentary, we had agreement about what was needed and had to be done and we worked as a two person team (with support from our partners and friends) to build CCAHS to do the unbelievable: change the face of the medical care delivery system in New York City and by extension, the State and maybe even the Nation.
We did not do that! But we came close so often that the imprint of what we did try to do is now still on the ‘To Do List’ and is partially covered by the Patient Protection and Affordable Care Act.
Wellness Coming Alive
But while that Act is a step forward in many ways, it delayed the day when America and Americans will have established the right to receive care as a “right”. That day will come when there is a universal National Wellness Service and Program (NWSP) which includes universal access to scientifically proven effective and affordable health services provided by all types of providers which have science to back their effectiveness. A NWSP can be provided on the Internet for pennies a year per person. The costs of a NWSP would be offset by the savings due to a reduction and mitigation in illness, disease and injury known to be preventable, amenable to reversal or able to be mitigated by wellness efforts. One major insurer in 2015 announced it is now offering its insured an Internet monitored Wellness Program which after tallying the compliance (but not necessarily the results) creates points then translated into cash refunds at the end of the year.
Mission and Changes
The Consumer Commission had a founding goal (‘Mission’), to provide information to effectively involve consumers and individuals and groups in planning, using and evaluating medical care. The strategy was to empower consumers and the tactic was the empowerment through the provision of information. The CCAHS publications were the means to implement both. At the point of creation, the Health Perspectives (later titled Consumer Health Perspectives starting with Vol. V, No. 1 April 1978 [Pub. 4/78]) were written to provide information normally kept from consumers and to connect it to health care delivery and financing.
The publications initially addressed the control of hospitals, the biggest expense component for payers. Later, the analysis of more complex issues was undertaken. CCAHS grew organically. The priorities set down by the Board and Professional Advisory Committee (PAC) kept shifting from one key concern to another. This was understandable as there were so many areas not previously explored, discussed, reported and analyzed for consumers. As examples, by commission and omission, CCAHS and its publications and services would look at the organization and financing of care but did not offer much in primary prevention or wellness. Later, CCAHS did expand its scope of reporting (i.e. the quality of care, safety of medical care received, the need to organize its delivery and financing, etc.) to patient-provider outcomes.
Consumers and Providers Impacted
What became ironically revealed was that the information CCAHS provided for the use and empowerment of consumers was information that many providers were also unaware of or denied. CCAHS’s first and continuing large support came from friendly union health and welfare funds. The continuing second group of support came from providers. As consumers tried to absorb the value and use of the CCAHS provided information, providers were fighting within the medical delivery provider and medical and hospital insurance communities. Providers and insurers almost always closed ranks when faced by demands by consumers to produce information. But as these communities realized that information once considered proprietary and confidential was now in the public domain and could no longer be withheld, the wall of mystery providers and insurers sought to hide behind whenever challenged would be no more. During the internecine war, the wall of secrecy crumbled.
Examples of these disclosure wars will be found below as each publication issue is described. But the overall background noise of the various social movements of greater scope and publicity makes it difficult to adequately describe how revolutionary the health consumer movement was then or to describe the role played by CCAHS, then and today. In the end the portion of the overall social revolutions was corrupted, compromised, co-opted and marginalized as the political landscape shifted towards the right, market orientation, capitalization and profit. It would take over thirty (30) years for the fruit to ripen, but CCAHS can be proud of its record to being one of the major organizations which started the integration of consumers into the processes of organizing and financing care and that impact filtered down into the consumer movement to be equally involved with their providers in the care they received.
ACA-Current Step In a Long March
On March 2010 President Obama signed the Patient Protection and Affordable Care Act (ACA). This Act incorporated many subjects addressed by CCAHS in its voluminous publications from 1973 through the early 1990s. For those who participated, supported or contributed to CCAHS, we dedicate this Website.
So Just Do It! And Enjoy.
So Don, and with modesty, I am thankful to you for the efforts we made over 40 years ago and recognize that the struggle needs to be continued with each generation. Please take this site and “Do it. Just do it!”