A celebration and reflection on reform

As spring dawns in America, we must gather to celebrate the final passage of legislation that will inaugurate national health reform. A new day has broken that holds great promise and hope for untold numbers of Americans who have lacked quality healthcare. We must consider: • More than 10 million uninsured Americans who have a mental or a substance use condition.
• More than 20 million uninsured Americans who have not been able to afford health insurance.
• Thousands of small business owners who have been unable to provide health insurance, even for their families and themselves.
• More than 8 million children and adolescents who lack any health insurance.
• More than 155 million Americans with a pre-existing condition.
• Millions of young adults under age 26 just entering the workforce for the first time.
• Millions of elderly Americans who cannot afford needed medications.
• Millions of Americans who have become unemployed during the past year. For each of these citizens, life became much, much brighter as the U.S. House and U.S. Senate passed historic and unprecedented national health reform legislation. To find earlier legislation of comparable effect, one would need to look to the Social Security Act of 1935 and the Medicare Act of 1965. We from the behavioral health field owe profound gratitude to President Obama, Speaker Pelosi, and Senate Majority Leader Reid, each of whom exhibited outstanding vision, courage, and leadership to bring us to this historic day. This new legislation will also encourage all of us to take great strides toward fulfilling the oft stated wish of President Franklin Roosevelt that pursuit of good health should become a basic human right of all Americans, just like life, liberty, and the pursuit of happiness. Imagine a future day when one would be able to pursue the best health possible in an equitable way, unfettered by major social and physical disparities. Clearly, this vision can serve as a major motivator for each of us. Several reflections seem appropriate to this historic occasion. As a society, we have been pursuing national health reform for a very long time—at least a century. Highlights would include President Roosevelt’s efforts in 1933 to 1935, President Johnson’s efforts in 1964 and 1965, and President Clinton’s efforts in 1993 and 1994. In each of these previous efforts, the mental health and addictions communities were not fully “at the table.” Now, we are. This is cause for great celebration, but it is also cause to mobilize ourselves. We must be fully on top of our effort going forward. We must also be prepared to assert ourselves in key ways. For example, we must be able to work effectively with large healthcare entities in an environment where integration will be the norm; we must be able to enter and participate in Accountable Care Organizations, where success will depend upon quality of care and good outcomes; we must be able to assert the centrality of consumer direction, peer support, and recovery. As full equals, we will not be able to rely any longer on our own inferior status to protect us. All of this changed radically in March. We became full equals. What should we do about this new status? In the short-run, we should celebrate. However, we must also engage reform immediately. An urgent need exists that we participate in conversations already underway at the integration table and at tables where Accountable Care Organizations are being formed. In fact, we need to become proactive and lead in these conversations. We offer quality behavioral healthcare, and we achieve recovery. This is an excellent starting point for a conversation with our primary care colleagues. I hope that you feel refreshed and re-energized, like I, by these historic developments. All of us—consumers, family members, providers, system managers—have worked ever so hard in so very many venues to arrive at this new horizon. I am sure that for many of us, at many points, it seemed as if this day would never arrive. Now that it has, many new opportunities will present themselves, and many new challenges will become apparent. Our success in achieving National Behavioral Health Reform will help us to define our path and move forward quickly in the new landscape. Nothing could be more exciting! Ronald W. Manderscheid, PhD, worked for more than 30 years in the federal government on behavioral health research and policy. He is the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors as well as a member of Behavioral Healthcare's Editorial Board.