Getting to Truly Comprehensive Healthcare Reform

President Obama declared the other week that there is a "clear consensus that the need for healthcare reform is here and now." Ensuring that his call for comprehensive reform hears "every voice" goes beyond applause-worthy sound bites, and translates into action, is vital to fixing what ails our current system.

To date, our current healthcare system has been deaf to some of those voices. Among those whose important concerns are often drowned out by the chorus that surrounds heathcare reform, are those representing the mental health and addiction treatment communities.

Many people don't naturally think that the mental health and addiction fields have something to contribute to the healthcare reform debate. But experts in these fields must be heard because addressing the causes, consequences, and treatment of these diseases is vital to constructing a meaningful and cost-effective national healthcare strategy. Including mental health and addiction squarely in the scope of health reform -- where they belong =- will contribute to the improvements we all seek in health status and controlled costs.

Today, our medical knowledge has advanced considerably since the foundations of our healthcare system were put in place. We know that mental health and addiction disorders are treatable and, when they are treated, significant cost savings are achieved. And yet we are wasting scarce dollars using hospitals and emergency departments as "holding tanks" for the untreated and getting poor outcomes in general medical care as a result.

Mental health and addiction disorders combined account for roughly one-fourth of total resource use in community hospitals. These disorders are involved in about 24 percent of all adult hospital stays, and 22 percent of total hospital costs. For the uninsured, they account for 33 percent of all admissions.

The numbers of people affected by addiction alone is startling. More than 23 million Americans suffer from addiction, but only one in 10 gets the treatment they need. University of Pennsylvania researchers studied the effects of alcohol or drug use, or both, on diabetes, sleep disorders, depression, and hypertension. They found that success in managing these four chronic conditions depends on concurrent management of addiction.

Congress acknowledged last year that we can not heal the system as a whole without considering all of its parts when it passed parity legislation. This new law bars insurers from imposing limits on addiction and mental healthcare treatment that are not applied to other health conditions. But it is not enough to ensure that these treatments won't be discriminated against by insurers; we must make these treatments are covered.

In healthcare, we already know that more expensive does not necessarily mean more effective. While America spends the most per capita on healthcare, those expenditures have produced a healthcare system that the Commonwealth Fund ranked as last in quality when compared with 19 other countries.

As we examine what's broken in today's system, the missteps of past plans, and the elements of a successful future system, we must remember that America cannot take a piecemeal approach to what ails us today. Addiction and mental health treatment must be a part of a comprehensive overhaul of our nation's healthcare system.

Comments

[Aginglawyer]

I am in agreement about the need to be inclusive in coverage in health care provision. I fully support the expansion of Medicare as an option/alternative to private insurance and as a simple way to extend health care coverage affordably under a system that has demonstrated it works. I have a longer post on my blog on this issue and the difference between National Health Insurance and National Health Care. see http://agingonedaily.blogspot.com/2009/03/extending-medicare-and-fairness-to.html . Assuring the inclusion of mental health care is a simple matter under Medicare expansion.

[PlaceboStudman]

A couple of questions, based on your blog....

1. It is able to establish rational levels of care provision.

What IS a "rational level of care provision", when you consider how many people already have so many pre-existing conditions. childhood cancer, lukemia and congenital birth defects, that their treatment likely will be considered so expensive as to not be cost effective, and thus would be cut in order to keep down costs?

2. It can more effectively encourage primary care and early care as well as preventive care.

Primary care, early care, and preventative care or great, but what of those of us who already have existing conditions that last 20-30-40 years or more, and will thus inevitably drive up the costs of the aspects already mentioned, in an attempt to keep those critical care needs at a reasonable price. It has already been established that people are no longer willing to pay more for better care, and these issues which would lead to better care for the disabled will inevitably be cut as people object to having their costs so high.

[PlaceboStudman]

Amen. This is the best article discussing one of the real issues behind true health CARE reform that I have yet seen on HuffPo. I applaud you for taking on this serious issue.

This is one issue that most people overlook, when they are concerned with "the big things" like surgery or a broken bone or what have you. But, what most people don't realize is how these issues are inter-related with mental health and addiction. It is now a well established premise that there is a direct connection between one's mental health and how well one heals. So, when a patient comes in and complains of one ailment, the best way to treat them is holistically, making sure that all systems are managed. When a person receives treatment, say surgery, it is often the case that the patient will develop depression or suicidal thoughts due to the pain and recovery period. Even moreso, there is an increase in the number of reported cases of drug addiction to prescription medications, given to a patient for what was originally a more accepted ailment. And when we are forced by addiction to depend on a drug or medication, that drug often does more damage to the body than the original ailment, and we enter into a vicious mobius strip of trying to stay one step ahead of our mental, emotional and physical health