Ezekiel Emanuel is “a fearless healthcare rebel,” according to National Council CEO Linda Rosenberg. Emanuel is a bioethicist, trained oncologist and political scientist, and he sketched the backdrop of the healthcare system at large during a keynote session at the National Council for Behavioral Health 2015 conference in Orlando.
The $3 trillion U.S. healthcare system is so large, it qualifies as the fifth largest economy in the world, above the whole of France, which has a $2.73 trillion economy. The spending is staggering and unsustainable. Therefore, behavioral health providers must increasingly be able to prove their worth in terms of cost reductions if they want to thrive in the future.
“Can you provide and demonstrate higher quality and lower cost going forward? That’s the key,” he said.
Eighty-four percent of spending is attributed to chronic care, according to Emanuel, and those with chronic conditions will be targeted for cost saving interventions. And that’s a huge opportunity because many individuals with chronic health issues such as metabolic and cardiac conditions often have co-occurring behavioral health diagnoses. He said $240 billion is tied to behavioral co-occurring disorders today.
“Once we’ve got our arms around chronic illness and improve quality and decrease cost, the next thing we’ll look at is mental health,” he said.
Emanuel also said he believes the United States will achieve mental health parity as more attention is brought to the law.
In January, Emanuel co-authored a viewpoint in JAMA, “Bring Back the Asylum,” which provoked national discussion. Emanuel’s point, he said, was to highlight the opportunity to create better systems of care for those with serious mental illness.
“We have let these people down,” he said. “My view is that what we need are modern asylums for those who cannot care for themselves.”
He said he envisions high quality, secure institutions that are far better than no care or criminalization, which is the common situation today.
“I recognize that in those circumstances, you might have abuse, but it’s not as if we don’t have that now [with the lack of care],” he said. “It’s a very tragic situation.”
After some prompting from an audience member, Emanuel also clarified that he understands people with mental health concerns cannot be permanently categorized into “harmful to self and others” and “functional,” and that the categories are not mutually exclusive. Individuals in the care process can transition. However, as a matter of policy, there are differences in optimal treatment depending on the individual’s current assessment so lawmakers will continue to look at individuals in terms of the two categories, he said.