“Changing the health care system is the work of a generation—not just one president.”
These words, spoken by Henry Aaron, senior fellow at the Brookings Institution and keynote speaker at the Department of Health Care Policy’s 20th anniversary symposium, summarized the day-long event. While it is hard to avoid alluding to the political landscape at a conference whose very theme is currently being spun by presidential hopefuls, the event’s primary message was clear: fixing policy is long, hard work. Another message was equally clear: the Department of Health Care Policy (HCP) has spent the last 20 years at the forefront of trying to change the system, and has a lot to show for it.
The event began with Barbara McNeil, founding head of the department, summarizing how it grew from a small group of four policy experts to its current size of 27 faculty members, many of whom are the most cited experts in their fields. Its educational impact has paralleled this growth in research. To date, the department has graduated 177 doctoral students and, in the last three years, more than 40 enrollees in their MD–MBA program.
Three sessions followed McNeil’s opening remarks: Quality of Care, Financing of Care, and Mental Health. In the first two sessions, HMS professors of health care policy Sharon-Lise Normand, Michael Chernew, and Joseph Newhouse discussed approaches to improving the efficiency of health care delivery—something that does not necessarily entail lowering costs.
The third session, on mental health, included presentations by researchers Richard Frank, the Margaret T. Morris professor of health care policy, and Ronald Kessler, HMS professor of health care policy. Kessler, who was just elected to the National Academy of Sciences, began with some sobering statistics. According to the World Health Organization, depression is the leading cause of disability worldwide. In fact, no physical disorders come close to causing as many missed workdays as mental disorders.
Showing data from the World Mental Health Survey Initiative, a WHO-run project that assesses the global epidemiology of mental health, Kessler showed the wide prevalence of mental disorders across countries as diverse as Brazil, Canada, Germany, Mexico, the Netherlands, Turkey, and the United States. The toll that these conditions take not only on the individuals but on their families, friends, and coworkers is striking. Kessler pointed out, for example, that attention deficit hyperactivity disorder and depression are the biggest causes of industrial accidents among coworkers. So employers cannot afford not to address the issue with employees.
According to Kessler, the good news is that mental health professionals have become very adept at treating conditions like anxiety and substance abuse. The bad news is they are ineffective at preventing them. Because we often know who is at high-risk in adolescence, Kessler said, “we need to develop school-based early-onset preventions for mild to moderate conditions”—particularly since such conditions are usually not severe at onset.
Frank reviewed the last half century of mental health care in a talk titled “Mental Health Since 1950: Progress and Unfinished Business.”
According to Frank, the last five decades have seen a marked improvement in how we deal with psychological disabilities. For example, as recently as 30 years ago, lobotomies were still being performed in the United States—20,000 in 1972 alone.
Since then, we have dramatically increased the nationwide supply of mental health professionals, such as social workers and counselors. Patients and doctors are both much more comfortable with the newer class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), which has led to increased medical compliance.
Still, less than 1 percent of the GDP is spent on mental health.
Henry Aaron concluded the event by pointing out that any effort to fix our health care system through magic bullets—like malpractice reform—will fail to yield real change. Instead, we need to systematically reshape the way we pay for and deliver health care. Easy to say, but Herculean to carry out, given the minefield of political pressures that have doomed previous efforts.
Which is precisely why this is the work of a generation.
