A few words from Alan Brownstein, CCAHS Board Member, December 2014
Don Rubin – “Some thoughts, but this ain’t no eulogy.”
I met Don Rubin in the late 60s or early 70s – it was at some meeting related to labor unions and health care. At the time I was the Director of Health Policy and Legislative Affairs for Local 1199/National Union of Hospital and Nursing Home Employees. I don’t recall exactly what Don was doing at that time but I remember he told me that his father, Jay Rubin was the head of the Hotel Trades Council, AFL-CIO, a powerful progressive force in NYC and the nation.
I was a really green 25 year old true believer and to me, Don was a wise and knowledgeable about NYC politics and health care. It was very clear to me at once that Don is an excellent listener and fully respected everyone’s point-of-view. Don defies labels, but to me, he is a blue collar Renaissance man; a progressive thinker, but not an ideologue. In fact, the only times Don showed impatience was with ideological diatribe. Don is a pragmatic progressive thinker who makes moves directed at human betterment (particularly in health care) and cultural enrichment. He also has an astute business mind as he cut through the anomalies of asymmetrical mostly unregulated hospital reimbursement in the post Medicare era. The hospitals were totally over-matched as Don negotiated well on behalf of his clients.
In January 1972, I was honored when I was asked by Don to offer some suggestions to the formation of a “Consumer Health Information and Protection Agency.” In February 1972, this idea came to life in a proposal prepared by Don Rubin and Ed Gluckmann for the creation of the “Consumer Commission on the Accreditation of Health Services”. CCAHS would seek to become a consumer centered counterpunch to the ineffective JCAH, and was organized as an “incentive for change in the hospital world”. CCAHS with its activist and diverse board of consumers and key opinion leaders in health policy produced quarterly and other publications that served as a laboratory of health reform ideas.
I was again honored a few years later when Don asked me to serve on the CCAHS Board and contribute to the CCAHS “Consumer Health Perspectives” publication on topics related to hospital regulation, gain sharing, home care, and others. Don was very kind. After I was terminated from my position as Director of a professional and trade association of home health agencies over different views of how the organization should be run, Don welcomed me as to use his office to serve as my base.
Over the next few years I had the opportunity to write and co-author several articles for the CCAHS “Consumer Health Perspectives” including “Home Care, Who Will Benefit: The Payor, The Provider or The Patient” with Barbara Dillon and Herb Hyman, and “Bed Reduction and Gain Sharing” which identified some health care system trade-offs that could be established in health planning and regulations that better serve population needs. I also had an opportunity to write a chapter in “Medical Technology, Health Care and the Consumer” – “Developing New Medical Technologies: Medical Technology and the Public Interest”.
In this chapter I advanced the idea that based on data assessment, some technologies should be identified for selective development where needed and, similarly, should be limited where determined to be of marginal value or potentially of negative value if misused. I identified “half-way technologies” that should not be advanced such as organ transplantation. I was very wrong and fortunately no policy makers even considered this suggestion. This was especially ironic in my case as I later served as president and CEO of the American Liver Foundation where organ transplantation was a highly effective procedure that has since saved many thousands of lives. I worked with Mickey Mantle’s family to promote organ donation. In my defense, I wrote my chapter before the development of cyclosporine, the miracle drug that prevented transplant rejection.
The point is that Don Rubin created a non-pretentious environment for health care policy wonks (before that term was used), people committed to finding ways of improving health care. Don Rubin’s CCAHS was a true incubator of ideas that worked and ideas that did not work. Working closest to Don was CCAHS EVP, Ed Gluckmann and Research Director, Shelley Frost – this trio made it work. And I remember the incredible hard work of so many – Herb Hyman, Allen Spiegel and the many consumer advocates, community and labor movement leaders who made sure that CCAHS kept its soul – Judy Wessler, Frank Goldsmith, John L.S. Holloman, M.D., Milton Terris, M.D., Florence Galkin, Peter Velez, Marshall England, et al.
Was CCAHS an idea before its time? Was Rubin a dreamer with unreal fantasies of changing JCAH and the health care system to reorient itself to “patient-centered care”?
Within the past couple of years “patient-centered care” has become a central theme to organize the health care system. It presumes active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. Given that non-consumer stakeholders often don’t know what matters most to patients regarding their ability to get and stay well, care that is truly patient-centered cannot be achieved without active patient engagement at every level of care design and implementation. The IOM (Institute of Medicine) defines patient-centered care as: Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design.
Don Berwick defined patient-centered care as: The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.
In its Declaration on Patient-Centred Healthcare, The International Alliance of Patients’ Organizations (IAPO) states that the essence of patient-centered healthcare is that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective. This Declaration sets out five principles of patient-centered healthcare: respect; choice and empowerment; patient involvement in health policy; access and support and information .
The embrace of the patient centered care concept by healthcare leadership in clinics and the policy level reflects the Rubin/Gluckmann founding principles of CCAHS. This is good news as it appears that CCAHS thinking of 40 years ago might be coming part of the establishment in driving health care. But then again, I have always been an optimist. They say “the difference between an optimist and a pessimist is that the pessimist has better data.”!
- Sepucha, Karen; Uzogarra, Barry, O’Connor, Mulley (2008). “Developing instruments to measure the quality of decisions: early results for a set of symptom-driven decisions”. Patient Educ Counsel. 73 (3): 504–510.
- Institute on Medicine. “Crossing the Quality Chasm: A New Health System for the 21st Century”.
- Jo Anne L. Earp, Elizabeth A. French, & Melissa B. Gilkey: Patient Advocacy for Health Care Quality.
- Berwick, Don. “What Patient-Centered Should Mean: Confessions of an Extremist”. Health Affairs Web Exclusive.
- International Alliance of Patients’ Organizations (IAPO, 2006). “Declaration on Patient-Centered Healthcare”.
An Introductory “Thank You”
There really are no words to adequately describe the commitment, dedication, knowledge and prestige the members of the Board, the PAC, Staff and volunteers made to the success of the CCAHS. So we will say nothing more but “Thank You!”
Chair: John McDowell* (Chairman, Director for Social Welfare, National Council of Churches)
President: Donald Rubin* (President, Medical and Hospital Consultant for self-insured payers)
Executive V. P. Edward T. Gluckmann, M.S.,*
Secretary: Richard Asche*, Esq., (Pollack and Singer)
T. Roland Berner, (Chairman, Curtiss-Wright Corporation)
Lillian Bloom, (Consumer Advocate)
Alan P. Brownstein, MSW, MPH (Executive Director, National Hemophilia Foundation)
Alice Fordyce*, (Vice-President and Secretary of the Albert and Mary Lasker Foundation)
Marshall England, (Consumer Advocate)
Jay Dobkin, M.D., (President, Committee of Interns and Residents)
Florence Galkin, (Nursing Home Consultant and Consumer Advocate)
Frank Goldsmith, (Workplace Health and Safety Consultant)
Gail Gordon, M.P.H., (Committee for a National Health Service)
Edward Hightower*, (Associate Director, Kings County Hospital)
John Hoh, (Brewery Workers Local 3, I.B.T.)
Herbert H. Hyman, Ph.D., (Professor, Hunter College, Health Planning)
Sidney Lew, (Labor Representative)
Clarence Jones*, (Publisher, New York Amsterdam News) Edgar O. Mandeville, M.D., (Private practice Obstetrician-Gynecologist)
Murray Ortof, PhD*, (Director of Consumer Affairs, Health Insurance Plan of Greater New York)
Rosina Reilova, (Consumer Advocate)
Lillian Roberts* (Associate Director, District Council, 37, State, County and Municipal Employees)
Joan Saltzman, (President, Community Advocates, Great Neck, NY);
Bernard Shiffman*, (Executive Director, Community Council of Greater New York)
Sol Silverman* (President, Local 140, Bedding, Curtain, and Drapery Workers Union)
Symuel Smith*, (Executive Director, Morrisania City Hospital)
Joseph Tarantola,* (President, Amalgamated Jewelry, Diamond and Watchcase Workers Union, Local 1, IJWU)
Milton Terris, M.D.*, (Professor and Chairman, Department of Community and Preventive Medicine, New York Medical College)
Mrs. Eleanor Tilson*, (Administrator, Medical and Pension Program, United Department Store Workers Union)
Benjamin Wainfeld, M. D.
Judy Wessler*, (Consumer Advocate)
Pedro [Pete] Velez,* (Administrator, Circle Manhattan Medical Group, HIP)
*Original Board Member. Parenthetical information listed for identification purposes.
The staff was often comprised of a changing group of dedicated volunteers, sometimes paid, and all overworked. It is quite possible some staff and volunteers have not been identified here.
Zita Feron, Research and Writer
Shelley B. Frost, Research Director and Associate Editor
Jane E. Gluckmann, Secretary
Frank Goldsmith, Director, Labor Health and Safety Institute
Roxanne Young, Associate Editor
Any publication organization needs a person or group known as the editor or the editorial board. Editors are usually considered more experienced and are also usually higher up the production chain. In the end, copy is submitted for publication and the editor’s job is to ensure its accuracy, necessity, and value in addition to ensuring that the organization’s style and message are correctly portrait. Many of the editors became editors by choice or assignment. All did the best that any editor could do in the cooker pressure of deadlines, copy space, etc.
Here are a few of the named Editors, including some who performed without title. We might have missed a few who will for now be unnamed heroes.
Edward T. Gluckmann
Herbert H. Hyman
A Special Note
There are two individuals whose efforts were not associated with an asterisk or holders of official positions of CCAHS until several years later. Shelley (Frost) Rubin and Jane Ellen (Frange) Gluckmann provided critical support and work to the CCAHS and ultimately came from behind their respective partners to make the National Science Foundation grant a success. Their efforts and those of other staff, especially Zita Feron, and members of the governing board and Professional Advisory Committee with special thanks to Herbert (Herb) H. Hyman, Ph.D. Later, Shelley and Don Rubin co-authored a book with David Spiegel, Ph.D. on Consumers and Medical Technology.
and a PROFESSIONAL ADVISORY COMMITTEE (PAC)…
The CCAHS Professional Advisory Committee Members included many foremost scholars, researchers and health and consumer executives. All were experts in their fields of public health, private practice and research and publication in the Greater New York City area. Many were also nationally known. .
George Baehr, M.D.*, (Founder and Board Member, Health Insurance Plan of Greater New York, formerly, Chief of Medicine, Mount Sinai Hospital)
Larry Bear, J.D.,* (Health Consultant; former Commissioner of Addictive Services Agency, Human Resources Administration; Broadcaster-Moderator of “Conference Call” Public Affairs Show, WABC, New York)
Leatha Catlett, R.N.,* (Assistant Director, Nursing Services, Morrisania City Hospital)
Bernard D. Challenor, M.D.,* (Assistant Dean, Columbia College of Physicians and Surgeons and Assistant Professor of Prevention Medicine, College of Physicians and Surgeons)
Lewis M. Fraad, M.D.,* (Acting Chairman and Professor of Pediatrics, Albert Einstein College of Medicine)
Jack Elinson, PhD.,* (Professor and Head, Division of Socio-medical Sciences, School of Public Health and Administrative Medicine, Columbia University)
John L. S. (Mike) Holloman, Jr., M.D.*, (former President, New York City’s Health and Hospitals Corporation; former President, National Medical Association)
Mildred Morehead, M.D.,* (Director, Evaluation Unit, Albert Einstein College of Medicine)
Don Meyers,* (Executive Associate, Associated Hospital Service of New York aka as Blue Cross)
Inder Persaud,* (Deputy Assistant Commissioner, Cumberland Hospital)
Symuel Smith,* (Executive Director, Morrisania City Hospital; former President, National Association of Health Services Administrators)
Milton Terris, M.D.*, (Professor and Chairman, Department of Community and Preventive Medicine, New York Medical College)
Philip Strax, M.D., (Medical Director, Guttman Institute)
Felix Wroblewsky, M.D., (Board Certified Internist; Director of Medicine and Medical Education, Brookdale Hospital Center).
*Original Professional Advisory Committee Member