xx AACP Newsletter, Volume 13, Number 1, Winter 1999
The Robert Wood Johnson Health Policy Fellowship: A Report from Washington
As many of my colleagues around the country know, I am spending the current academic year in Washington, DC, doing a Robert Wood Johnson Health Policy Fellowship. This article describes the first phase of this experience and some anticipation of what will happen during the next nine months, when I will be working in Congress to assist in the development of health related legislation. For those of you who don't know me, I have been a member of the AACP Board of Directors for nearly ten years. I was the Medical Director for Mental Health Services West, a large community mental health center in Portland, Oregon for the past 11 years. I also have been the Associate Director of the Public Psychiatry Training Program at Oregon Health Sciences University. During my experience in these positions, especially with my work on the Oregon Health Plan, I developed an interest, and substantial experience, in health policy development.
I am joined by six other fellows, all very interesting and enjoyable people. We are in the midst of an intense three month orientation to the legislative ins and outs of the federal government, provided by leading policy wonks, legislators, lobbyists, and others both within and outside of the government. The fellowship is administered by the Institute of Medicine, an amazing think tank, part of the National Academy of Sciences.
It has been a whirlwind experience: the equivalent of a masters degree in public health, taught by the most expert and contemporary faculty imaginable, in a real world classroom, compressed into three months! No actual final exam or thesis is required; however, the work we accomplish during the coming nine months of actual congressional staff time will be a demonstration of our ability to absorb what we are taught and to apply it meaningfully.
Our contacts have been quite impressive. You probably couldn't pay for the time of the illustrious faculty we have had, considering their busy schedules, high political or academic profiles, and the fact that they have been doing their sessions with us in seminar fashion, one to several hours at a time in small group discussions. Every person we have met is incredibly bright, energetic, and articulate (not the image of inveterate and craven politicos and bureaucrats), even those whose politics or values I disagree with.
Our sessions have included encounters with leading policy wonks from within and outside of the federal health establishment. For example, we had a whole day with Lynn Etheredge, a prominent health economist whose fingerprints are all over many of the health policy initiatives that have been passed in the past few years. We also spent a day with Gail Wilensky, another health economist, who was the head of HCFA (the Health Care Financing Administration) under President Bush, and who is a self-described free marketeer. Another delightful day was spent learning about the federal budget process from an entertaining and self-effacing, but extremely brilliant political scientist, Allen Schick, currently with the Brookings Institute. We spent half a day with a team of lawyers from the Department of Labor, learning all we could about the important ERISA law, whose many provisions affect how employment-based insurance can or cannot be subject to state regulations or liability law suits. We had an enlightening meeting with the dynamic and incisive Secretary of Health and Human Services, Donna Shalala, who gave us her perspective on what health care reforms are possible and how they will likely occur.
We met with professional organizations (such as the AMA, Academy of Pediatrics, American College of Internal Medicine), trade groups (the insurance industry and pharmaceutical industry's representative organizations, the National Committee on Quality Assurance, the hospital associations), and the whole continuum of political and policy think tanks (from the Urban Institute to the American Enterprise Institute to the Employee Benefit Research Institute to the right wing Heritage Foundation and ultra-libertarian Cato Foundation), as well as various special interest groups representing specific populations (like kids or older folks) and services (like welfare). To top it off, we have been meeting with the staff of those Senators and Representatives who show an interest in health issues, many of whom are interested in having us work for them as the new Congressional session begins in January.
We continue to be amazed at all we have learned and what potential productive work we might be able to do in the coming year. The current political opinion is that this session may end up being very productive, partly because it will be a non-election year. The need to make up for the do-nothing reputation the Congress earned during the last session and the many urgent health-related issues that must be addressed (such as Medicare reform, patient protections from managed care, privacy of medical records, tobacco controls, and addictions treatment parity) also may induce the members of Congress to work in a more positive and collaborative fashion, especially now that the Republican leadership appears to be reconsidering the effectiveness of its more partisan legislative strategy. One can only hope so. For the benefit of our patients, both those with and without insurance, they need to stop bickering and establish solid, useful mental health policies.
Keep tuned to this space for future news from DC.