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Giving Perspective to Our Expectations


Keep health reform’s expectations in perspective
Implementing a century’s worth of vital reforms will take time—it won’t happen overnight

by Ron Manderscheid, PhD, Executive Director, NACBHDD

This year has been very momentous and tumultuous. Health reforms needed for at least a century have succeeded, and implementation has just started. These reforms are desperately needed to promote our overall health and well being as a civil society.

I am sure that you recognize that the United States cannot be competitive in a global economy without a healthy population. As a society, we are in imminent danger of producing a generation of children with worse health and a shorter lifespan than us, and who are also less well off financially than us. Fortunately, we now have the opportunity to avert these tragedies if we support the reforms that are currently underway and see them through to completion.

Our instant communication society also promotes a desire for instant gratification. Just as we expect someone to respond to an e-mail within minutes, we also expect the new reforms to work immediately, almost even before the ink is dry.

One example: We know that one cannot correct overnight the consequences of decades of poor eating habits and sedentary lifestyles. These poor habits, fostered by an economic system that did not value good health and a healthcare system that did not incentivize good health, have led to a population with epidemic levels of obesity, early-onset heart disease and other chronic killers. We now confront this very harsh reality.

And, because these health problems arise not only from personal but social factors, e.g., poverty, and institutional factors, e.g., production of high fructose foods, their solution will be long term, requiring implementation of major social and related economic reforms. Literally, we have just taken the very first steps on a very long journey.

Fortunately, we understand this situation, a situation that should not lead us to recline, but rather to incline toward the hard work that you, I, and all do to make national health reform truly successful. In both the mental health and substance use fields, that will involve new patterns of care, new partners, and a new perspective on health promotion. These are not small tasks. It is very important that we do not underestimate the time and effort required for success or allow others to do so.

Yet, the rewards for undertaking this challenge can be tremendous: Mental health and substance use clients who live longer, healthier, and more fulfilling lives in their communities; a reduction in the prevalence of these conditions as prevention efforts advance; and better health for everyone as we address the social and physical determinants of poor health. How tremendously exciting!

At this time, we must recognize others who have worked so hard to bring us to this tipping point. I speak here of President Obama, whose vision never flagged throughout the protracted national health reform debate and of Majority Leader Reid and Speaker Pelosi who persisted in crafting reform legislation through periods of great difficulty when it seemed that health reform was dead. To each of these leaders, I say a resounding “Thank you!”

Now, let’s demonstrate by our action that the point has truly tipped!

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