J. Miller, Ph. D.
Health Care Reformer
Miller’s interest in health care reform started in 1994
as managed care began to control health care services. Early on
he realized that managed care practices cut quality and accessibility
of services as readily as they cut costs. The managed care structure
required so much money to pay for its bureaucracy that it needed
to cut valuable services and create barriers to treatment in order
to be profitable.
Dr. Miller’s response was twofold. First, to protect the
integrity of his practice, in 1994 he developed a managed-care-free
practice and also established the Boulder Psychotherapists’
Guild, Inc. The Guild is a model for the ethical marketing of
mental health care services. It offers consumers accurate information
about the benefits of mental health services so that they can
make informed choices about using those services. Instead of relying
on insurance companies to make referrals, the Guild gives consumers
information about individual psychotherapists so that they can
find a therapist who met their needs. In 2006 the Guild has 78
members and has become a national model for ethical marketing.
Second, Dr. Miller addressed the larger issues of health care
delivery. In 1994, he published a book about the negative impact
of managed care on mental health services, “What Managed
Care is Doing to Outpatient Mental Health: A Look Behind the Veil
of Secrecy.” In 1996, he published four peer-reviewed
articles about the economic, ethical, quality, and accessibility
problems resulting from managed care. One of these articles reviewed
the entire body of research used to justify managed care’s
use of ultrabrief therapy. He found that a scandalous 100% of
this research had been misquoted by managed care. Instead of supporting
ultrabrief therapy and managed care imposed time limits, the research
indicated the opposite, that managed care had a negative impact
on outcomes. This finding was reported at the Dr. Harold Eist,
President of the American Psychiatric Association (ApA), 1997
ApA Convention Presidential Press Conference.
To further health care reform, he has been active as a Board Member
in the Colorado Psychological Association, has served on two committees
of the American Psychological Association (APA), is a Board Member
of the Division of Independent Practice of APA, was the Committee
Chair for the Consumer’s Right to Know Legislation Committee,
was a founding Board Member of the Colorado Advocates for Responsible
Mental Health Services, was a founding Board Member of the Colorado
Ad Hoc Committee to Defend Health Care, helped establish the Colorado
Mental Health Insurance Action Line, was a Board Member and Executive
Director of the National Coalition of Mental Health Professionals
and Consumers, Inc. (NCMNPC), was Chair of the Board of Directors
of the Patient Advocacy Coalition, and is Chair of the Board of
Directors of Balanced Choice Health Care, Inc.
Several years into his activism, he began to search for better
ways to design a health care system. Dr. Karen Shore, President
of the NCMHPC, suggested the idea of gap payments in a reform
proposal that she called Managed Cooperation. Although this proposal
was limited, it stimulated thinking about the idea of restoring
consumer cost consciousness and finding an alternative to managed
As Executive Director of the NCMHP&C, he prepared a supplement
to a white paper, Collusive Behavior in the Managed Care Industry,
which was presented to the Anti-Trust Division of the Department
of Justice. This paper examined the economic systems underlying
insurance-driven health care, managed care, monopolies, monopsonies,
and free markets. Through this process, he realized that the current
economic models for health care are dysfunctional, and that changing
the underlying economic structure of health care is essential
for designing the best possible system.
In order to both achieve universal coverage and restore healthy
economic forces, he realized that two plans would be necessary.
The difficulty with other two-tiered proposals had been that the
second tier is prone to under-funding and cannot protect the poor
from being limited to substandard care. In 2003, Dr. Miller came
up with the idea of the Mandatory Funding Split, which preserves
funding, and consequently quality, in the Standard Plan. This
was a key idea necessary to create a complete system.
An early version of Balanced Choice was entered into the O’Connor
Report, “Build an American Health Care System” contest.
Balanced Choice was one of the finalists, but did not win the
top prize. Feedback indicated that this early version was too
difficult to understand. Audiences generally responded positively
to the Balanced Choice ideas, but promoting Balanced Choice needed
a reference document, a book, to clearly describe the entire proposal.
Since the contest, Dr. Miller has used his time and energy to
develop a comprehensive and clear explanation of the Balanced
Choice proposal. It is now available in Balanced Choice: A
Common Sense Cure for the U.S. Health Care Systems.
Dr. Miller believes that Balanced Choice is the proposal that
has the best possibility of resulting in desirable health care
reform. It is a proposal that creates functional market dynamics
and provides universal coverage. It accomplishes this without
government price controls or managed care. It satisfies the concerns
of both liberals and conservatives. It costs less overall than
is currently being spent on health care. It is the most beneficial
proposal for consumers, providers and employers.
As Chair of the Board of Directors of the nonprofit, Balanced
Choice Health Care, Inc., Dr. Miller continues to use his time
and energy to promote health care reform.
more information about Dr. Miller's innovative health care reform
proposal and how it provides universal coverage, visit www.BalancedChoiceHealthCare.org.
Balanced Choice: A Common Sense Cure for the U.S. Health Care