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Taking Issue   |    
Breakdown Dead Ahead
Arthur Lazarus, M.D., M.B.A
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.10.1087
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When Boz Scaggs wrote the song "Breakdown Dead Ahead" he surely did not have health care in mind. But the fact is that in 2006 U.S. health care costs averaged $7,026 per person. By 2017 that number is estimated to shoot up to $13,101. By all accounts, there will be a breakdown of the medical system as a result of unsustainable health care spending, which has consistently outpaced growth in the gross domestic product.

When I became the medical director of a struggling psychiatric hospital in 1996, I worked to ensure that approaches to controlling costs were in place: disease management, pay for performance, drug utilization reviews, and other initiatives. Nevertheless, costs kept rising, and the hospital was eventually sold to avoid bankruptcy. The lesson was clear: learn to work the revenue side of the equation as well as the cost side. The approaches we used addressed only the latter.

A few of my colleagues who work in the not-for-profit sector think that they are immune to cost pressures. But I remind them that not for profit should also mean not for loss. In fact, universal health care will not save us from a breakdown, because the nation's health care crisis is a crisis of both uncontrolled spending and fragmented care, not to mention poorer access and health care outcomes for racial and ethnic minority groups who already have health insurance.

Health care is shaping up to be one of the biggest issues of the 2008 presidential election. Caregivers can help alleviate many problems in the health care system simply by keeping close tabs on spending and eliminating waste. Integrating medical and psychiatric services and implementing care management programs, wellness initiatives, and evidenced-based pharmacy programs may also reduce the economic burden of mental illnesses.

Every year that slips by without an effective antidote to the fiscal crisis ratchets up the pressure and the likelihood of an unavoidable call for urgent action. So please begin taking action today. To paraphrase the Flobots, the most talked-about newcomers in rock and rap circles, we should try to counter rising health care costs with the tools of our trade—implementing clinical innovations, engaging in patient advocacy, and influencing the political process to improve health care quality. The Flobots song "We Are Winning" concludes "Fight with tools. Your fate and that of everyone you know depends on it.

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