We need to dramatically expand access to counseling

With each passing day…sometimes even within a passing day we are reminded of how mentally sick we have become. Yet, still, the idea of access to sustained mental health counseling and care is not a priority. We spend enormous sums on crisis care. If we just had the will, we could pour enormous resources into the kinds of services that would greatly reduce the need for crisis services. Whatever we spend, whatever it costs, the investments will be more than repaid in the gifts of a more mentally stable nation.

“Community Health Needs Assessments” (CHNA) from Maine to Hawaii identify our “social determinants” of health status. These assessments in reality report out the same sets of concerns. Our nation is too emotionally fragile. This fragility manifests itself in poor nutrition, sad living conditions, loneliness and isolation. The more we seem to be coming together with the advance of communications technology, the more we seem to be using these technology wonders to isolate ourselves. We don’t ride a bike down the street or across town. Instead we join a peloton from a stationary cycle in our home. It’s just so much easier this way.

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There aren’t too many experiences more overwhelming than being sick and trying to deal with the U.S. health care system. All of us have personal stories of disconnected providers and lousy communication. “It’s like nobody talks to anybody around here!”

As a health leader it is always embarrassing to listen to the stories of friends and family who were left on their own. My response was to put in place clinically trained care navigators whose job was to stand with the patient and help them in every way (even if that help meant sending the patient to another health provider). Many other health providers have taken similar steps. But this idea really needs to be as universal as the coverage we want everyone to have.

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The historical model of private health coverage in the U.S. has been to obtain it through your employer. This model doesn’t work anymore. We need a system of care that reflects current culture. The social contract of employment has changed, so health care access needs revision too.

We’re not lifetime employees anymore.

My parents were part of a generation that spent their entire careers with one employer. Company-sponsored health coverage worked well because there was so little movement. Many employers even granted continued coverage in retirement. It is long past time to acknowledge how much this social contract has unraveled. People entering the workforce have a much greater probability of multiple employers while living in many different geographies. Only governmental employees now seem to build long tenures of service.

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In recent weeks Democratic candidates seeking the party’s nomination have given their preferences about how to reform U.S. health care. My experience in over 30 years of community hospital leadership led me to agree with the comments of John Delaney that Medicare-For-All would be a financial disaster for the vast majority of American hospitals. Very few U.S. hospitals have costs at or below Medicare payments.

Yet I don’t agree with Congressman Delaney’s statement that we shouldn’t touch the private health coverage market that covers 100 million Americans because those people will want to keep their coverage. I think there are a great number of Americans in the private coverage spectrum who have been saddled with enormous up-front deductibles and large co-payments and ever-narrowing health provider options who are ready to talk.

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