Copyright 1999 Federal News Service, Inc.
Federal News Service
OCTOBER 21, 1999, THURSDAY
SECTION: IN THE NEWS
LENGTH:
1082 words
HEADLINE: PREPARED TESTIMONY OF
RONALD
SMITH
VICE-CHAIRMAN, DEPARTMENT OF PSYCHIATRY
NATIONAL NAVAL MEDICAL
CENTER
BEFORE THE HOUSE GOVERNMENT REFORM COMMITTEE
CRIMIANL JUSTICE, DRUG POLICY AND HUMAN RESOURCES COMMITTEE
SUBJECT -
EFFECTS OF SUBSTANCE ABUSE PARITY
IN PRIVATE INSURANCE PLANS UNDER MANAGED
CARE
BODY:
My name is RONALD EARL SMITH. I
am a Navy Captain and Doctor of Medicine. I am currently a consultant in
psychiatry, addictions and psychoanalysis at the National Naval Medical Center,
the Pentagon, and the United States Congress. I teach and supervise residents,
interns and medical students at the Uniformed Services University for the
Health Sciences on a daily basis. I am certified by the
American Board of Internal Medicine, the American Board of Emergency Medicine,
American Board of The Psychiatry and American Board of Addiction Medicine. I
hold a Doctorate in the Philosophy of Psychoanalysis.
It has been my honor,
pleasure and pain to work in the field of addiction medicine and treat
alcoholics and addicts for 27 years. This work has been primarily in academic
centers- in the emergency rooms, critical care units, psychiatry wards, and
addiction units. I have worked in private practice, the military and the federal
and state systems.
Over these years it has been my sad experience to watch
our culture decrease money for active primary treatment of addiction and
mental illness. The limited funds remaining after budget cuts
have been moved to other forms of institutionalizations, primarily jails and
prisons. Instead of hospital beds for treatment, our culture builds prison beds.
The bulk of the homeless population is there because of substance abuse and
mental illness. As Chairman of the Department Of Psychiatry in
a prominent west coast hospital, I watched the mental health
unit close because of funding problems. Five years ago, in the National Capital
Area, there were three excellent military inpatient treatment units, one each at
the National Naval Medical Center at Bethesda, Walter Read Army Hospital in the
District, and Andrews Air Force Base in Maryland. Today, as a result of
decreased funding, there remains one outpatient treatment unit at Andrews Air
Force Base.
Treatment works. Indeed alcoholism and addiction are the two
illnesses/behaviors which are quite fatal and completely treatable. The average
alcoholic affects the lives and psychological and physical
health of five other people. The California and Oregon studies
show clearly the monetary return to the state of dollars spent for treatment. To
the best of my knowledge this seven for one return of dollars invested in
treatment did not include the more subtle and hard to measure- but very real
payoff in reduced learning disabilities, attention deficit disorders, and
divorce rates. These conditions are so common in the family dysfunction induced
by addiction that they are seldom measured. The complications of alcoholism and
drag addiction remain the most expensive diseases in medicine and include HIV,
AIDS, brain trauma, paraplegias, cardiovascular disease, diabetes, complex
infectious diseases including TB, Klebsiella pneumonia, and HEPATITIS C, fetal
alcohol syndromes and severe psychological problems resulting in life long
dysfunction for many family members. As a physician working and teaching long
and wonderful hours in intensive care units and emergency rooms, I continue
today in wonder--Why will private and public insurers pay willingly for Delirium
Tremens, respiratory arrests due to Heroin overdose, strokes due to Cocaine,
life long paralysis due to driving under the influence, severe gastrointestinal
bleeding, and liver transplants while continuing to decline adequate primary
treatment for the very addictions which cause these vicious complications. Why
not treat the earlier stages- parity for addiction treatment-
when it is much less expensive, more interesting, and a lot more rewarding for
all concerned.
The Honorable Jim Ramstad knows treatment works. He also
knows that addicts and alcoholics, probably because of denial, will not demand
good treatment benefits when they initially review their health
plans, and that private insurers because of price/earnings ratios and stock
price indices will not write adequate coverage because of the possible, very
minor, short term increase in premiums. In an ideal world the federal
legislation for parity in substance abuse would not be an
issue. The health care crisis in this country is far from
ideal. Ultimately the federal government picks up the cost of addictions by
funding prisons, courts, special education, and health care for
the uninsured in the form of Social Security Disability, Medicare and Medicaid.
Why not ask and demand help from private industry, the very group that claims to
treat disease better and more efficiently than a federal health
care system. Why not treat addictions like other fatal and less treatable
illnesses by providing parity.
I know treatment works. The
United States Navy knows treatment works. The United States Navy wants sober
pilots in fighter planes and sober physicians taking care of these pilots and
provides excellent treatment because treatment is cost effective, efficient and
the right thing to do. The recovery rate for pilots treated in the Alcohol
Recovery Service at Naval Hospital Long Beach was 85 per cent. The recovery rate
for 220 physicians treated there was 80 percent. The overall recovery rate in
the Navy has remained about 70 percent.
The Betty Ford Center in Rancho
Mirage, California was built and designed utilizing the model of treatment
developed at the Naval Hospital Long Beach. The Betty Ford Center in one of the
more successful treatment centers in the world and the Betty Ford Center knows
treatment works. President and Mrs. Gerald Ford know treatment works. President
Carter and his family know treatment works.
The evidence that funding for
treatment is inadequate and ineffective can be seen today within steps of this
Capitol in the ever increasing homeless population. The growing number of
expensive jail and prison beds reflect a culture that is all to willing to treat
severe end stage complications of alcoholism and addiction rather than treat the
illnesses primarily, when it is cheaper and more effective for all concerned.
Private insurance companies are no more to blame than myself, all of us sitting
in this room, the federal and state governments, and/or the paradigm shift in
medicine and health care. But private insurers with the help of
this legislation can lead the way in treatment and do it cost effectively.
The Ramstad bill provides a capacity to begin the shift in dollars from
prison beds to hospital beds, from homelessness to homes and work.
PASS THIS
LEGISLATION NOW!
END
LOAD-DATE: October 26,
1999 
