Conversation 517-005

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How are you, Mr. President?

Good to see you again, Mr. President.

Good morning, Mr. President.

How are you?

Good to see you again, Mr. President.

How are you?

hot potato we talked about, it seems like, ten generations ago when you first came in.

I'm excited to tell you, too, that, you know, just excellent reports on your salesmanship, the way you're getting out and presenting that, you know, kind of new converts to our point of view.

I don't know how it's going to come out in the end, but we

somebody with high potentials that you have.

I don't know.

I don't know what it is.

I think I would have agreed with you on this.

We could go out there and challenge and seek authority on these various things.

It's not what we did.

We agreed with this.

And I withhold that what you would do.

I mean, that's what I had in mind, at least, as far as I understand it.

It's a good idea.

deal of this already.

In fact, in the interval preceding by several weeks the actual introduction of the health legislation and following that up.

Roger, I don't know how many books you've seen and talked with already.

Well, I've talked with about 40 in our office, but also probably 60 or 80 across the country.

I want you to know that I deeply admire and respect you very warmly.

And I think the health plan is something that one can really fight for.

The arguments fall into place so much that it's a pleasure to go out and do it.

And that is that we, you can't run a health program without the doctors.

And you can sell that on the second hand.

But beyond that, there's a whole lot of skeptics, you know, that you agree with.

Or they just, for everything, doctors are rich and selfish.

And some think that they're not gonna, a lot of them, a lot of them are just wrong.

Some are partially correct.

So, what you gotta do is to convince those skeptics that we really have a good program, and we have.

and say, well, gee, there are a lot of sick people and a lot of people in need of medical care and here we're going to give you a lot of dough so you can have it.

Well, that's the easy answer to all problems and always the hard answer.

Because to take people and say, look, we're going to give you the wherewithal in order to purchase what you need and then to find that there's no market for it, it compounds the problem.

Because they then realize that

that is actually hopeless.

So now we're, I think we just have the right balance here between the supply side and the demand side and all these intricate fellows I understand.

So I guess all of them are these, I guess you feel like these, what do you call them, one of them?

and that's been a very successful enterprise as i understand it

I think it's important to not make them think that everybody's going to be in an HMO, but whether we thought it was a good idea or not, that couldn't happen in six or seven years.

Not that they have.

No.

But we... Not that they are.

Yeah.

That's... And what we're seeking to develop is the opportunity to follow along.

This is one of the things we... Yeah.

Roger and I had a reason...

They were complaining that some of our promotional material seems to suggest that everybody will be, or 90% of the people will be enrolled in HMOs by 1980.

What we've actually said is that we hoped that we could develop the opportunity so that people would have the option, 90% of the people would have the option by 1980.

We want to create a wider race.

We want to preserve the pluralism of the present system.

And not to straitjacket it.

I think it's a very strong, strong part of our case.

You feel, you feel, you feel strong.

I feel very comfortable.

I feel thrilled.

I think there's some things that have to come along, and I think we're already working on them.

The, um,

We're going to have

come down to drugs as mental illness.

Yes, for a lot of people.

But alcohol is, too.

Of course it is.

People, I think drugs are even more than alcohol.

Sometimes people will drink in order to, well, just drink to have a good time.

I mean, because they're having a good time, so to speak.

Whereas a person who takes drugs takes drugs to get high.

Now, an individual who drinks, who drinks alcohol, may not be drinking to get high.

You know, you've got to socialize with them.

There's a very subtle difference.

If you drink too slowly, you've got to drink it to get high.

It's just that process.

We've all got a mental problem, right?

We all have a mental problem.

And, of course, there's a fine line here because, you know, there's a lot of legitimate medicine prescribed through programs.

But then they get themselves into a lot of other issues.

I followed this right on.

Elliot heard me kick psychiatrists around for quite some time as a group, but I realized that first and most fascinating part, it would seem to be of all medicine.

and which in our complicated society is the greatest problem.

And I think you're going to have those mental health things that's going to be your next big push.

Don't you think so?

I do.

As a matter of fact, I had just within the last three weeks started to develop and pull together some information on which to judge whether to recommend to you.

Yes.

Can you grab?

This sort of thing came up in the Academy the other day.

Welfare reform is and should remain down to the wire a major effort.

Of course, I think the chance is pretty good in calendar 71.

The health thing will be in the forefront going into

and probably down pretty close to the wire, maybe even the very end of the congressional session 72.

And I don't think that within the HEW, of course you've got special revenue sharing for education, cancer, cancer will have, you know, that'll go through all right.

That would be, and so I don't think we can or should,

and try to come up to you to do and be with anything of very, you know, comparable scale.

But mental health, I think, for several reasons, offers a potential opportunity.

In the first place, the preliminary data I have tend to show that community mental health systems have had

a real impact on reducing the actual cost of long-term hospitalization.

It is quite clear that it has.

We've done a better job in ATW, and the review and evaluation of the effectiveness of this is different from any other area of the department's activity.

So when you combine the investment that is represented by accessible community-based

in one of these great factory warehouses where the insane used to be stacked away.

When you combine that sheer dollar return factor and the salvaging of human lives that is represented by a shorter-term period of intensive therapy versus indefinite, et cetera, with the alcohol and the drug-related aspects of the situation,

uh you know it becomes a it needs a reason anyway why i think this is an area that we ought to devote a good deal of attention to between now and the development of 73. we're gonna get a pile of projects there i know you have some

well ideally what we have here is under the 63 legislation is that is enough of a base of data with respect to the effectiveness of these programs already the real issue is going to be whether whether we will seek to lead a national commitment to extend the system to a genuinely national network of services and it is now the percentage of the

It is that much, yes.

That's all, sir.

enough case for the effectiveness of this system to justify your saying the nation should now, in the light of this, the experimental period is over.

We know that it works.

We know we need it, especially because of these other things.

And so now let's move.

And I think, given the strength of the constituency that is involved here, too,

in the mental health associations and so on.

As it so happens, the president of the National Association is a friend of mine with whom I worked on mental health legislation in Massachusetts.

He was then the president of the Mass Association.

He is a Republican and a good friend and a very savvy operator.

So that we may have a real opportunity to parlay this

I'd like to talk to you this fall.

Because I have a special kind of an interest in this, to be honest with you.

As I said, there's so many quacks that you were talking about.

On the other hand, when I go to medicine, you know, I know very well, I mean, I know my own person, just personally, and families and so forth and so on, and all the other individuals, you know, that you can get some of the psychosomatic

to cut your medical expenses about a half.

That's going upstream, and that's what you've been advocating.

What's that?

That's going upstream to make your diagnosis right here.

Right.

That's what I've been pushing for you, and this is the case.

Oh, that's very important.

I thought that it had a particularly well, it sounds true to a lot of people to look for it, but the whole

eight of us people have.

So many of us are here.

Yes.

That's where the ulcer starts.

That's where high blood pressure starts.

That's your brother, sir.

Relationally, the other day, sometimes, I know they sometimes may end up physically, but an individual can't be sick without having an ulcer and high blood pressure, right?

Oh, yes.

Yes.

People come to me and they look like they have a little bit of pain in my heart or I feel bad or something.

They say, there's nothing wrong with you.

Just go home.

Well, that's all right for a strong attorney in law.

But it's like the old family doctors.

The family doctor was about half psychiatrist, wasn't he?

He would listen.

He would talk and so forth.

And that individual is really sick when he has the...

That's why when I, as I told you earlier, when you ever read that book, my friend Hutschnecker's The Will to Live, which was many years, 15 to 20 years ago, you can get a copy, Rosen had a good copy of it.

And his analysis is, he's an internist, but also a psychiatrist in Minnesota.

But his analysis is burdened in just case by case where the line between the individual who is really sick, I mean, he has a heart attack, he has a heart problem, and he really has, and the person who doesn't.

But his point is that both are sick.

Now, by that he means the individual is just as sick, and that's the thing that we've got to understand.

And so that brings me over to the drug problem again.

Why do people take drugs?

Well, there's frustration, there's a thrill sometimes.

The alcohol, that's part of that, too.

You don't go behind the fire and roll in the car, so that was part of it, too.

But then you get over this area, and once you experiment a bit, I guess, then they take it for the purpose of receiving, giving away, and so forth.

And there are people with sort of personality deficits.

They just lack capacities equitably to cope and to feel like complete people.

And the drugs help them to fill that void.

Well, it causes the kind of life which ruins their whole life, because it's when they should be creating their lives.

Yeah.

Well, as a matter of fact, too, they're even having a pretty bad time, too, because of the whole cycle of, you know, nail town, et cetera, et cetera.

a lot of that served probably very, served, did serve, and does serve a very useful purpose, you know, for some people.

I mean, they're a hell of a lot better to take a mill down and be hacking or climbing a wall.

Although, then there came a point where many were over, over, as I understand, some doctors told me they went overboard on this, and then people would, I mean, they'd said, even with a drug as mild as that, have a

I've seen a deep breath line for militant.

Have you?

Yes, when they were withdrawn.

And Peter Mark doesn't take care of the Pacific for militant unless you've found out that this was early.

But he found out it was Miltown they were taking.

He gave them Miltown, didn't he?

Well, now tell me this.

Is Miltown a drug, you know?

No, it's a very different kind of a drug.

But why did they die then?

What's the reason?

Well, you get habituated to it, and then they take increasing doses.

Yeah.

The tendency with Miltown and Pinot Bar, is you forget you took your medicine.

Yeah.

So an awful lot of people that were starting on medicine by a doctor,

begin to use tremendous amounts, because that's part of it.

They forgot they took it.

And the doctor has been extremely negligent in not picking those days up.

But then they go on, and they become addicted the way they ought to, or if you call it addicted.

But anyway, the peanut butter.

Then let's say you stop them, or they come to the hospital in a coma.

If you don't give them further meltdown, they switch over to convulsions.

And it was much harder to take a man off of phenobarbital than it is off of heroin.

We talked with the Mexicans in Los Angeles.

We can get anybody off heroin.

We just take them in our pad.

We take them off heroin.

We need the help here in the hospital because several we took off phenobarbital died.

They died in the hospital.

You've got to do that over a period of almost a month.

Now, there's a drug where a lot of people use.

Yes, those are the most important, because they're a tremendously used sedative, and in the right dosage.

It's a wonderful sedative, but then people take them in ten or a hundred times the dosage, and you get a very different kind of feeling from them.

They often take combinations of amphetamines and barbiturates.

They have this fine upper and downer effect.

Speaking of which, you made a point at breakfast we had the other day about getting together with the doctors.

And I thought it was an exceedingly important point, which we are following up with the idea of seeking the enlistment of medical organization leadership, starting with the ANA and then working through the state society, to involve the doctors in this drug problem on two fronts.

overuse or overprescription of drugs and the other to give doctors an updated education in the treatment of the problems of drug abuse and drug dependency.

But most of them went to medical schools when the problem was much less prevalent and much less had to show up in the range of their own practice.

And the result has been that they have tended to duck

the situations in which they might either want to actually assume the possibility for treatment or at least be enough aware of what they were seeing so that they would recognize it early enough to get the kid into somebody else's hands earlier.

And so this, I think, is a very appropriate supplement to all the other things that are going on.

We have a meeting set up with the ANA, I think,

this underway and lay plans for it.

And I think this really was triggered by what you said.

I think it's very helpful in your meeting.

And I might put a little line in when I speak of this.

As I told you when you were here before and when you first came on, I mean, I defend the medical system.

But I think they have been, and I think you would agree that they as an organization have been, I mean, they've had their heads in the sand too damn long, and they've fought, and they've fought, frankly, mild proposals that have now brought on much more radical

And we've asked various types of people, we're asking various types of people to go out and try to educate kids, young people, about drugs.

Now, who are the believables?

Why do you think about like Art Linkletter, whose daughter died from the shot that older girl sued?

Let's see.

He's very believable.

In other words, Art Linkletter and Jeff Skremski, the Boston ball player, is out talking to kids about this.

You've got celebrity types.

You have the ministers do it.

They preach to them and so forth, and that's good.

The educators, it occurs to me that the most effective ones could well be the doctors.

I mean, basically there's a fear in them.

If the individual isn't here, here's the doctor.

Get up there and eat.

He just says, no, look, I'm looking at this solely scientifically and so forth and so on.

It has nothing to do with morality.

You see, you don't get them on the morality kit.

They'll turn them right off.

What I'm getting at is that the doctor, the doctor basically is a professional man.

And the doctor is a lawyer.

He does not go into politics.

He can't.

In other words, he's dedicated to his life.

On the other hand, he said he has had a superb education.

And during the course of his life, both he and, of course, even more his wife, have been exposed to all the public interest problems and so forth.

They want to do things.

Doctors in many communities, I have found in my own campaigns, you get doctors and doctors, they can be very extremely, I don't mean they'll all do it, but I think that my own little town of Whittier

We had a couple of doctors out there.

One became the chairman of the board of the college and another became the chairman of the city council.

They were enormously influential, respected men.

My point is this.

If we could get the AFA to take on a program where doctors, and particularly some of your, I mean, basically who are pillars of the community,

with gifts and they go in and give lectures lectures on look kids i'm not here to moralize about this thing and i'm not here to say that you shouldn't drink smoke uh fornicate or whatever people do but i do say this don't do this to your body and your mind i think that had a helping effect you see is this has this been tried and done much to have the doctors as a group done much of this

Can't we enlist them?

I think we should try to enlist them.

And I think that if you said that and when you talked to them, it would be a very important thing.

You see, they, the people, are more than anything else, they need education.

Young people.

So, who tells them when they hear, the kid says, well, look, I've been on this stuff, the grass, it doesn't mean much.

Or I, I mean, I take a little heroin or whatever they do.

And they go, buddy, that's just trying to get it.

you know, to keep you like they are.

But boy, the doctor gets out there and talks.

And first of all, I think they've rendered a hell of a service.

And I think it would be the greatest sense of self-satisfaction for them, gratifying themselves, to be doing something other than their very, very important task, of course, which was saving lives.

I think that's a very good idea.

It fits in with these other things because

The doctors themselves, they say, need more in case of their own... Yeah.

What you need with DeGroote, if you could explore this with him, and there's another thing.

There's another thing.

The medical profession is like business.

A recent poll has been taken by O.R.C.

on the attitude of the American people toward business.

Zilch has been going down in the last 10 years due to the various attacks, environment, and a lot of other things.

A lot of it on affairs, I want to testify, consumerism, nadirism, etc., etc., etc.

as a group, are not a popular people in the world.

Now, there is a way, and what I'm getting at is, when you've got 75% of the American people, 75% is against about 9 or 10%, that consider drugs an enormous problem.

When you've got parents worried and so forth, I think doctors could make themselves extremely, they could get on a popular cause here, and take the leadership, and they could be the ones to say, well, Dr. So-and-so is doing this,

In other words, let the doctor get out in front on an issue that people are concerned about.

It'll help.

I think it's a good idea.

You three gentlemen, if you can't make it, I can follow up by bringing in an R.I.P.

member I talked to.

I think that's a good idea.

Thank you, sir.

Over this, and I hold a congratulation to you on your foreign and domestic policy.

I'm really thrilled.

We have to fight.

Oh, wait a minute.

You got it before you know what you did, and I think you got it, sir, sir.

How much we all owe.

Thank you very much.

Thank you, sir.

You mean I should get one, sir, Richard Nixon?

You better.

I owe you.

I can just see a doctor going into, I can see a doctor going into a high school class and say, I'd like to talk to you a little about this.

And he said, and he did talk to the media, and he said, no, I'm not going to talk about it.

I don't have a reason to talk about it.

I talk about this and that.

I have an obligation to tell you what the names are.

Be sure to say it.

You want to do this for yourself, you can, but here is what happens to you.

That would scare the hell out of somebody.

I think the price would be better than a lot of these.

You're the boys who do the decent, so it's right.

Thank you.

I'll get this on the monitor when I get around to 30 feet.

All right.

Mr. President, this is Senator Cooper, sir.