Outgoing coalition President Karen Shore suggested that if mental health clinicians want to retain or regain decision-making authority for patient care they will have to accept a cost-control mechanism that "balances freedom with some responsibility for cost." For mental health care office visits, she suggested, a model would be to have a fixed dollar insurance reimbursement for each visit, with a sliding copayment scale that would be negotiated by the patient and clinician. A government program would provide part of the copayment for the poor, disabled, and those with serious mental illnesses, Shore explained. The country also needs a system in which clinicians can base their fees on location, training, and experience, she added. Also, no insurance plan should ever prohibit a patient from paying completely out of pocket if he or she want to ensure absolute privacy, said Shore.