National Council`s 40th Annual Conference: Howard Dean

Howard Dean, physician and former governor, presidential candidate, and head of the democratic party, opened the National Council's 40th annual conference with his general session "A Prescription for Real Healthcare Reform." And in true Howard Dean fashion, he didn't hold back when it came to his feelings on reform, both for behavioral health and healthcare in general.

"The parity bill is a significant, but not huge, improvement," Dean told attendees. "The bill is entirely in the private sector. Insurance bureaucrats are the problem, not government bureaucrats."

He blames the insufficiency of the bill on policymakers' lack of knowledge and experience in the behavioral health field, as well as their unfamiliarity with diseases of the brain. "We have a long way to go in understanding the brain and translating the policy of delivery into the policy of finance," he said.

Dean proposed a solution to the parity effort's shortcomings, one that is rooted in his home state of Vermont's own accomplishments in the behavioral health field. He emphasized the availability of wrap-around services, such as supported housing and education, and prevention strategies in small, community-based services as the means to achieving true reform.

"We need to teach state governments that investing in these services is worth it," Dean said. "We waste money because we don't invest." He also noted that smaller-scale services, rather than those that are "managed" by large insurance companies, have a greater chance of working correctly.

Dean's discontent with the behavioral health system is matched by his disappointment in the Senate's proposed healthcare reforms. "We need a thoughtful, rational system and [the current system] isn't it and the Senate bill isn't it," he said. "This notion that suddenly we're going to reform healthcare and it's going to be market-driven is insane."

He thinks that a healthcare institution led by practitioners and operating under a regulated budget cap would be the ideal reform. In this system, the practitioners in charge would make more rational, cost-effective decisions and would not hesitate to integrate wrap-around services into reform because they understand the expensive consequences of not doing so. "Doctors, not CEOs, should be having this discussion," Dean said.

But despite the Senate bill's shortcomings, Dean still wants it to pass, agreeing with an attendee who stood up to comment that it may be more important to provide coverage first and figure out the payment system later. "I want it to pass, but if it does pass, then it's just the beginning," Dean said. "We need to figure out how to deliver healthcare in a fully integrated way."

Dean's emphasis on reform and integration was supported by several other National Council workshops on Monday's agenda. Related sessions focused on "Healthcare Reform Around the Globe: Lessons Learned"; "Integrating Medical and Behavioral Healthcare: A Public-Private Partnership"; and "All Healthcare is Local: How States are Thinking About Healthcare Reform." Other workshops on the agenda focused on addictions and co-occurring disorders, board governance, children and youth, clinical services, finance, health information technology, and personal stories of recovery. Photo Credit: John Pettitt / DeanForAmerica.com