It’s no secret that politics is an oft-maligned profession. One of Ronald Reagan’s favorite quips, “It’s been said that politics is the second oldest profession. I have learned that it bears a striking resemblance to the first,” reflects the essence of the matter. Yes, politics is about many things, but to be certain, it isn’t about perfection. Over the past twenty years, AAP/PLAN has supported hundreds of candidates who are not only sympathetic to psychology’s concerns, but many have been instrumental in pushing forward our legislative agenda. Regardless, I’d bet there isn’t a single one among those hundreds who would completely satisfy the average psychologist’s requirements for being a “perfect” politician. What’s more, if we held each politician up to the scrutiny of the larger group in psychology, I am certain consensus could never be reached about any candidate’s merit.
This is not meant to be an indictment of politicians. On the contrary, it is more a statement about the diversity of opinions existing among psychologists and the amount of growth that is needed among psychology’s rank and file in order to develop a fully functioning psychology advocacy program. We are anything but a homogeneous group when it comes to our political beliefs. In this regard, we are not unlike the general population of voters today where there is more divisiveness than ever about candidates and political parties. Psychologists have strong opinions about a wide range of matters, sometimes to the detriment of advancing the field. Take for example the recent polarization we see in psychology concerning prescribing privileges, or the recent interrogation of military detainees controversy.
Many believe that we psychologists tend to have a greater than average number of political liberals among our ranks. I don’t doubt this, but I have been surprised by the substantial number of conservatives there are among us. They are not a very vocal minority for obvious reasons. Moreover, the social leanings of all psychologists on issues ranging from abortion rights, to gun control, to immigration reform, to you name it, are all over the map. AAP/PLAN strictly avoids involvement with or support of any of these kinds of matters. AAP instead focuses ALL of its attention and resources on the one area in which there is universal agreement among the ranks, promoting psychology in the public policy arena. Psychologists, despite our strong traits of independence, are in the main, collectively united about the importance of advocating for the science and profession of psychology. We all assign a high priority to advancing the values that psychology can bring to the public whether it be in the health care, research, science, or academic arenas.
Unfortunately, there are still many psychologists who haven’t gotten the message that to advocate effectively we need roll up our sleeves and get involved in all aspects of the political process: lobbying, grassroots activity and political giving. This is not breaking news, of course. You’ve read this same screed repeatedly in the pages of Advance for the past 20 years. An early Greek “psychologist” some 2,500 years ago said it quite succinctly, “One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors.” Say what you will about Plato, but he knew what he was talking about on this issue.
Most of our colleagues still don’t appreciate how critical it is for us to support legislators who will be allies for psychology at both the federal and state levels. While all the other issues mentioned above and more (abortion rights, gun control, immigration reform, etc.) may remain high top priorities on a personal level for each individual, psychologists must evolve to the next level and recognize the critical importance of separating their personal agendas from their professional ones. Our profession can’t afford the luxury of supporting only “perfect” candidates who meet all the various and sundry litmus tests that so many psychologists claim to utilize to determine who will receive their support.
Pragmatism appears to be a foreign concept to many among us. We need to heed the words of the great German statesman, Otto Von Bismarck, “politics is the art of the possible”. A case in point which is illustrative of what I am referring to occurred last winter. In March, Olympia Snowe (R-ME) was honored at an AAP Leadership Dinner. Her record of support on matters of great significance to psychology during her combined 32 year tenure in the US House and US Senate has been exemplary. Even so, AAP received a fair amount of criticism from some quarters in psychology for selecting Senator Snowe as an honoree, much of it from psychologists from her own state of Maine.
The central theme of this criticism revolved around the Senator’s unwillingness to cast her vote in support of the final health care reform bill (HCR) in late December. While she was the only Republican to vote the health care reform bill out of the Finance Committee in October, she did ultimately vote against the final bill on the floor of the Senate on Christmas Eve.
It must be pointed out that the Senator’s opposition to the final bill was not just some contrived matter resulting in a lockstep party vote. Senator Snowe had repeatedly stated her belief that the status quo in health care was unacceptable. Her dedication to crafting an HCR bill is what originally motivated her to join with a group consisting of six members of the Senate Finance Committee last summer in the only bipartisan effort in any committee of the House or Senate. The so-called Group of Six, convened by Finance Committee Chairman Max Baucus met 31 times, week after week for over four months, to debate policy and politics was absent. Snowe said she was troubled that when the Finance bill was melded with the measure reported by the Senate HELP committee it was without the more inclusive, collaborative process participated in up to that point and instead it was done in the shadows, without transparency, just to garner the necessary 60 votes and nothing more. She felt the final Senate bill had taken a dramatically different direction since the Finance Committee bill. The final bill was 1,200 pages longer and included a new employer mandate that Snowe felt could annihilate the job growth potential she thought was vital to the economic recovery.
These are just a few of the objections she raised before the final vote. Whether you agree with the issues she was concerned about or not, it would be a real stretch to say she had not been anything but an honest broker with regard to HCR. Her final position before the vote, was to urge her Senate colleagues not rush to vote and she suggested that instead of taking a 3 week recess for the holidays, the Senate should return to Washington to continue debate about HCR on January 4th.
It borders on being ludicrous to accuse Senator Snowe of: attempting to drag HCR down, or simply voting party line, or just trying to block any measures that the Democrats might propose, or being opposed to any HCR at all, as was the case for many who voted in opposition to the bill. But that is precisely what a surprising number of psychologists expressed during the months leading up to the AAP Snowe dinner. Following are only a couple of the many responses received from tens of psychologists who declined to contribute to the Snowe dinner:
“I am not sure what position she will take on important questions related to psychology such as medicare reimbursements, but given her position on the current effort to reform health insurance I don’t see how I can contribute to fund raising efforts on her behalf.”
“I have to say I am so extremely upset by Olympia Snowe’s obstruction of the passage of a national health care reform plan that I am going to be working *against* her re-election. I think she’s been bought out by the insurance companies and big pharma.”
A reasoned response to these and similar statements to those above is as follows: “It is understandable that for many it was disappointing that the Senator didn’t support the HCR bill in the end. But it is vital that we as a profession mature to the point that we recognize that elected officials will not be in synch with every issue we believe all of the time.
Olympia Snowe has made many contributions to improve the mental health of all Americans during her career in Congress and she has been a staunch supporter of psychology’s legislative agenda. Most recently, for instance, Snowe introduced the Mental Health Co-payment Equity Act which reduced the co-insurance requirement amount for Medicare psychology visits from 50 percent to the 20 percent level required for all other Medicare visits and eliminated discriminatory co-payment rates for outpatient psychological services in Medicare. In addition, Snowe co-sponsored The Lane Evans Healthcare Benefits Improvement Act which would ensure that veterans suffering from mental health disorders will receive necessary support and treatment. She was an early and vocal supporter of the historic Paul Wellstone Mental Health Equitable Treatment Act. She has been very supportive of the restoration of psychologists’ reimbursement rates under Medicare. Although she did not concur with the HCR bill that was finally passed in the Senate, her attempt to work out a compromise was undertaken in good faith and her proposal was genuine and of considerable merit. She will continue to play a pivotal role in health care especially because the composition of the Senate is likely to contain fewer Democrats after next Fall’s election. That will make reasonable Republicans like Senator Snowe even more influential than she is currently. The impact of spending 2-3 hours of time at a dinner immersed in psychology’s issues will no doubt influence Olympia Snowe to be an even stronger advocate for psychology and mental health concerns than she was previously.
Don’t assume that disagreeing with a legislators position on a single issue is the only reason (“excuse”) psychologists raise to justify their non-participation/contribution to events like the Snowe dinner. Our colleagues are quite creative, of course. One who declined to make a contribution to the Snowe dinner responded as follows:
“I’d be pleased to support financially any candidate that supported legislation that allowed appropriately and ethically trained psychologists to prescribe psychotropic medications, as per APA policy. Given that Senator Snowe, to my knowledge, has not even been approached by the APA on this issue, I am going to decline your request to support her, or any other candidate any APA governance body puts forward, without first knowing their stand on this important issue to us all.”
Never mind that this issue is not one over which the U.S. Congress has any jurisdiction, other than the VA and Indian Health Service.
Prescribing privileges are a scope of practice issue that falls under the jurisdiction of individual state laws. Thus, state legislatures and governors control psychology’s future on prescriptive privileges for psychologists. The APA Practice Organization has provided substantive support for the efforts of many states with a great deal of money and legal resource availability. At the federal level, AAP and APAPO supported the federal military psychologists’ training program. This is the model that states use to refute psychiatry’s baseless claim that psychologists who prescribe will do great harm to patients.
Following are only a few more of the many additional reasons psychologists routinely give for the their non-involvement in the political process. Each is followed by a brief rebuttal:
Can’t afford it—if every psychologist contributed just $10/ month, psychology would have the largest PAC in the health care industry, by far.
Supporting this candidate doesn’t benefit me—when psychology succeeds all those in the psychology family benefit.
I already pay dues to APA to advocate – APA is legally prohibited from any involvement in the political process, although some lobbying activities are permissible, political action is forbidden for a variety of legal and tax reasons.
I don’t believe in buying votes – no votes can be bought, but access to educate elected officials is facilitated through campaign support.
Our research data provide sufficient evidence to support the need for the legislation we are requesting – Decisions in Washington are almost always based at least as much or more on political considerations as they are on research/facts.
For too long, psychologists have avoided full participation in political action. The entirety of psychology’s political action program is still riding on the shoulders of far too few of us (less than 10%). I know that if you are reading this column that I am writing to the choir. But we need your help on this. Please have a personal conversation with a colleague. Make it a point to reach out to as many colleagues as you can and urge at least one colleague to join with you in supporting psychology’s advocacy efforts. Sit down with them and show them how easy it is to participate at: www.aapnet.org. While it is true that we aren’t causing change to happen as fast as we’d all like, we are doing what’s possible, in true Von Bismarckian fashion.