In order to understand the urgency of the situation, we need to begin to grasp some of the larger issues.  For years there have been rumblings around the edges that we need to do something about health care, that Medicare and Medicaid programs cannot be sustained at the current levels and that we are not getting from our health care system the quality or the results that one might anticipate.  The current “crisis” and push for reform seems to be driven by three separate but closely related forces.

1. There are currently over 40 million individuals in this country with no health insurance.  These are individuals who for a wide variety of reasons do not qualify for Medicaid or Medicare and they have no private insurance.  Because of this their health care is at risk.  Likewise, when they do seek health care, they often seek it at the most expensive point of delivery within the health care system – the emergency room.
2. The cost of health care; the cost to provide health care continues to rise much faster than inflation, than wage increases, etc.  The cost of health care continues to consume a larger and larger share of our total economic resources each year.
3. The rise in health insurance costs has driven many businesses to either pass along most of the increase to employees or to cut the amount of insurance they offer.  Double digit premium increases per year are not uncommon.   The cost of offering health insurance to employees has driven some business out of the country.

Those three forces seem to be agreed upon forces that must be addressed.  Almost no one believes that we can continue forward as we have in the past.  But that is about the extent of the agreement! How to provide coverage for the 40 million, how to lower the overall costs of providing health care and then how to slow or reverse the premium increases are at the heart of the debate that began in the House of Representatives and the Senate and then spilled over into Town Hall meetings this past month during the August recess.

Part of the issue is that we are talking about reform and not just adjusting the system.  In order to address the core issues, we are going to have to talk about reform.  Most of us support reform, but at the end of the day, what we really want is to keep the old system but just get a larger share of the resources.  If everyone who is part of the health care system and every association supporting a specific disease wanted this, the system would go broke this afternoon!  That is why reform is so important.  How do we provide coverage to the 40 million and how do we reduce the over all costs to deliver health care?

For those of us involved with addiction, there is a real opportunity for us to not only present our case, but also offer some real reform models.  Any healthcare reform must:

1. Ensure that all Americans are provided with a benefit that provides treatment for addiction;
2. Ensure that all Americans have access to both the benefit and to treatment;
3. All decisions made about this disease and the treatment of this disease must be made by certified physicians;
4. Addiction is a chronic disease and therefore additional resources must be committed to managing the disease over the life of the individual with the disease;
5. We have to begin to think about stabilizing the disease and then managing the disease…transfer not discharge.

In just a few short weeks, the legislators will return to Washington and the debate and discussion will again pick up.  We have been working hard to be sure that the above five points are included in any version, any proposal, any draft of healthcare reform.  We will need your help to keep this issue front and center as we move forward.  We have an opportunity to achieve real health care reform and real inclusion of addiction as a health issue which must be in any reform plan implemented.  It will take the energy of all of us together to achieve this, but it must be done.