The federal government might seem to have an endless supply of money to fight wars, but when it comes to healthcare—especially behavioral healthcare—Congress has been inclined as of late to look for ways to reduce and control spending. Take, for example, the Deficit Reduction Act. The DRA reduces Medicaid spending and gives states increased benefit plan flexibility, and state officials are taking advantage of this at record speed (For details, see pages 8 and 32).
I suspect that if the federal government spent its money more wisely it would have more money for Medicaid and Medicare, which politicians always tout as national priorities around election time. You surely are familiar with stories of government largesse and waste (my recent favorite being $68,000 worth of dog booties that went unused because they did not meet the needs of dogs assisting Gulf Coast emergency responders). Perhaps one solution would be to reduce the size of the bloated federal government to increase efficiency, reduce redundancy, and decrease costs. It would not surprise me if bureaucrats found billions more that could be used for healthcare funding.
To do our part, we could suggest changes within government agencies concerned with behavioral healthcare. For example, do we really need three separate arms of the National Institutes of Health devoted to behavioral health (the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse)? Surely there must be a way we could give them a common mission, reduce their administrative costs, and create a leaner organization. The same goes for SAMHSA and its Centers for Substance Abuse Prevention, Substance Abuse Treatment, and Mental Health Services. In fact, now might be an opportune time for lawmakers to look at SAMHSA's structure, given that a new SAMHSA administrator will be coming onboard soon (see page 10).
I'm not suggesting the government eliminate these agencies' functions or spend less on their core activities. Instead the feds should reduce redundancy and use tax dollars more effectively, so that we free up more funds for Medicare and Medicaid.
I concede that my ideas are unlikely to become reality anytime soon. But as the baby boomers age, real and painful changes will be needed to keep Medicare and Medicaid in pace with our expanding and aging population's needs. With increasing taxes amounting to political suicide, government reorganization and reduction would be a much more popular solution. And with the field's input, perhaps agencies related to behavioral healthcare could be reorganized in a way that reduces costs—but not their effectiveness.
So the next time your local congressman or senator calls for looking at ways to reduce the growth of Medicare and Medicaid spending, tell him that you instead have some ideas for a “Government Reduction Act.”
Douglas J. Edwards, Editor-in-Chief