The nomination of former Sen. Thomas Daschle as secretary-designate of the U.S. Department of Health and Human Services has focused attention and built anticipation around the potential for national health reform. Recognizing this, Kathryn Power, director of SAMHSA’s Center for Mental Health Services, convened a major meeting of constituency groups on December 17 to plan CMHS’s next steps.
Similarly, the Whole Health Campaign hosted a Daschle “house party” on December 18 to build consensus around reform issues for the mental health and addiction recovery fields. Results from the house party were submitted to the new administration through www.change.gov. They also are being presented to transition officials.
From all indications, it seems quite clear that national health reform will focus on health—how to keep and enhance it. This will mean a major emphasis on prevention and early intervention. It also will be a wonderful opportunity for us to promote the concept of recovery as an essential consumer-directed tool for health enhancement. To me, it is very useful to think of this entire process as “making health a noun.”
In the past, health generally has been an adjective relegated to second place. The emphasis in healthcare is on care, not on health. Here, health is definitely an afterthought, because we really mean illness care. My own research and that of others shows clearly that illness and health are two separate dimensions. Hence, working on one (i.e., illness) does not by itself promote the other (i.e., health). The brilliance of the concept of recovery is that it bridges these two dimensions.
If national health reform does emphasize health, especially whole health, then our approach to illness care will be different in the future. We will start with population health and develop ways to enhance it, perhaps by using population health coaches. To make this whole health, we will include mental health and addiction health, not just physical health. We will emphasize consumer and family knowledge about health because such knowledge will promote recovery and self-determination. We will approach chronic diseases as a major opportunity for prevention and mitigation, not just for maintenance care.
I must also hasten to add that making health a noun will be essential to assure that national health reform will be a part of national economic recovery. Two underlying rationales leap immediately to mind.
First, a primary focus on health is a must if we are to control the spiraling cost of chronic illness care, which now consumes 75% of our $2.3 trillion illness care budget. Second, good personal health of all Americans is essential to the United States’ global competitiveness.
Within this broad-reaching focus on health, we will have other important tasks in national health reform. We must assure that health insurance coverage is extended to the approximately 17-18 million persons with mental and substance use conditions currently uninsured. This will be a complex undertaking, since many of these persons are unemployed. Furthermore, the fast-growing rolls of the unemployed are expected to swell this group’s size even more.
By itself, health insurance coverage will not assure good access to quality illness care. Hence, another critically important task for us will be to engage in major system reform. We must identify, promote, and implement models of good, integrated illness care based on evidence. These models must encompass mental illness, substance use, and primary care services. To do this effectively will require that we learn much more about the different medical home concepts primary care leaders are considering.
Finally, we must promote payment systems that reward high-quality care that achieves significant outcomes. To participate effectively in these payment systems, we quickly must reach consensus on a small set of outcome measures that can become the basis for rewarding performance. In this regard, I expect that the era of pay for performance is just around the corner.
Although not acknowledged nationally, every bit of this work assumes an important human value: Good health is a basic human right. Let's hope that we are able to establish this cardinal value as another American right that parallels "life, liberty, and the pursuit of happiness."
Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm SRA International, Inc., worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board. To contact Dr. Manderscheid, e-mail firstname.lastname@example.org.