Advisor Newt Gingrich discussed AOR’s mission, and why we urgently need to follow the science and change our approach to opioid recovery, during a panel on mental illness hosted by NAMI Ohio at the GOP Convention. Hear his speech.
First, I think you have to talk about not parity or the inclusion. Any more reordering of the brain, the clearer it is. Any health analysis that does not include the health of your brain and the health of your mental system is in fact inherently false. Look at the impact of depression on physical health is pretty clear that to say, “this person is in great shape” when they are totally depressed, is a nonsense comment. So part of what you have to look at is how we look at the whole person, and the whole person is by definition as a social status, a mental status and a physical status, and the three interact in ways that you have to take into account for the complete person.
Second, I think the greatest area of recluse in our understanding of human health is the brain because the brain is so complicated, and we’ve only really had good imaging capabilities for about 20 or 25 years. The volume of data is so enormous, and I once posted a series of Nobel Prize winners to talk about just the Alzheimer’s component, the average brain has about the same amount of little synapses as there are stars in the known universe. That’s one brain. Take this entire room and you have probably 200 universes. The volume of data that serious brain studies have generated is so enormous that storing it and analyzing it probably requires two generations of investment in computing—and we really don’t have the storage capacity or the analytical capacity to deal with the volume of data that we are starting to generate. Now why does that matter? It matters because we have the potential to go to stunningly personalized medicine, where we are really designing almost specific drugs for you, specific therapies for you, not for 7 million people. We don’t currently have the pricing model for doing that and we don’t currently know how it is going to operate, but 3-D printing will almost certainly be part of it. But we really are at the edge of enormous breakthroughs. And so that is the optimistic positive long term side of it that requires us to think about reforming the payment system and to figure when in suffice, for example when including mental health and including brain science in your—and starting with the federal government’s own public health systems and working with them.
Now a couple of very brief things I wanted to talk to you about. I personally am advocating very strongly that we move to a totally new approach on brain science, that we challenge the 37 or 40 thousand people who are specialists in that area, to tell us what is the optimum they could invest and then thus over the years we build a multi-year contract, even though we have an annual budget, I think we need to have a multi-year contract to build a momentum in brain science and my argument is, as a fiscal conservative who as the only speaker of the house who has been known to under balance the federal budget, I really believe that you can never get back to a balanced budget until you have a breakthrough with Alzheimer’s because the cost is just going to skyrocket. Rather than have bureaucrats try to micromanage, red tape, and minimize costs by avoiding care, I would rather emphasize breakthroughs in science. We don’t worry about the costs anymore of iron lungs because polio vaccine eliminated it. Which is the best way to lower health costs, by having people healthy. So what I would do is have an all-out effort to understand the total brain, and pay for it by taking a budget initiative which I would call “Alzheimer’s Bonds” with an understanding that, as we made breakthroughs and lowered costs, we would take the savings to pay off the bonds. Now I choose Alzheimer’s for two reasons. One is it is the widest spread example of the people over 55 fear and the cost structure is so stunning—an estimated 20 trillion dollars in public and federal money between now and 2050—and that understates it because Alzheimer’s caregivers are about twice as likely to have health problems as people who are not caring for Alzheimer’s patients. So there is a huge secondary cost. Second, we need to think about various systems of part-time care because there are people who don’t need to be in a facility—but the truth is the exhaustion of dealing in a home, if it has to be seven days a week, is beyond of a lot of people’s capabilities and so somehow we’ve got to go to a very mixed morrow that is profoundly different than where we’ve been. And lastly, in general, we had a theory in the 60s and 70s that we would include state hospitals and we would somehow manage to take care of everyone—but we have, we put them in prisons. Now I would argue that that is a dramatically less acceptable future and that one of the things that we’ve been talking about, for example in opioid recovery, is that why aren’t the federal prisons deeply engaged in helping people recover. And if you enter as an addict and you leave as an addict, you’re going to have a very hard time reentering life. On the other hand, if we used prison to both educate you and help you, whether it’s through an opioid maintenance program or whether it’s through complete detox—and I understand how there are huge arguments about which of these is the right track to go—if you talk to Patrick Kennedy about this he believes deeply that opioid addiction is very different and much harder than alcohol to cope with—in fact he thinks that a great deal of the overdoses are people who temporarily went through withdrawal. And when they start to break down again, they give themselves the same dose they used to be able to take, but because they now went through detox, their bodies literally can’t cope with exactly the same quantity. So it’s a very complicated issue.
So I think that we have to look at rethinking prisons—I have been very active in a group called “Right on Crime” and we work very hard with Van Jones and others to work on criminal justice reform—but I also think we have to think about the role of people in community. One of the projects we are on, which several million people thought was funny, is the use of smartphones to help people who are homeless. And immediately people say that the homeless are helpless and can’t do anything—well it’s not true. And we actually have an encouraging scholar up in the institute to run an experiment to see if there are ways you can empower people who are homeless to do a variety of things because their smartphones can help them in ways – and it turns out that they don’t lose them and they don’t sell them because they came to realize that this is something that makes their life better and they’re not going to be homeless. But for example, it does mean you can work with them with where to spend the night and you can do a variety of other things, which actually more than pays for itself just in emergency situations. So I’m just giving you a flavor of how we have to think differently and have to approach the veterans administration, and when they come up here, it is an enormous problem. And it is an enormous problem because it is a workforce larger than the marine corps. And it is a very bureaucratic structure that is integrated into a computer model, which in 1990,1,2,3 was a brilliant breakthrough. In the early 1990s, the VA was probably the best user of health information technology in the country. the problem is they still use the programming models of the early 1990s. Now there are 10,000 programs that operate in obsolete technology. And I’ll just give you one example: they have huge problems with reservations. And with matching up the veteran and the doctor. There’s a firm called ZOCDOC, which is a commercial firm which matches up your input and your zip code, you have 40 different specialties, you check off the one you need; they search in your area for a doctor and what they discovered was the average doctor has every fourth patient cancel. So every day they have 2 or 3 hours where they don’t make any money because they don’t have a patient. What ZOCDOC does is it finds out what doctor near you has a spare hour, and they reduced length of time in NY from 18 days to 24 hrs. they currently make 5 million reservations a year. We took them to the VA. We said, “you have a great reservation program”. They said “we do about the same number of reservations as you do, sometimes 400 more a week”, because the whole system is computerized. The VA probably said “here are the 17 things you’d have to meet for us to consider you, starting with you giving up all your extra”. And so there is no way they were going to do it because we have a 200 million dollar project for guys issued in the 1990 computing capabilities. And so we have to really rethink it. We also have to recognize that—and I have one of my closest friends who resorted to suicide suffering from PTSD who went from over prescriptions and working with the VA—and we really have to rethink how we approach mental health in the Veteran’s Administration because it is a different set of complexities from 20 years ago. And changing big bureaucracies is very hard. Not impossible, but very very hard. So anyway those are some very general overview thoughts. Now I thought I’d open it up to questions, comments.
Mr. Speaker, I’m Erin ? the CEO of the Romney’s? National office and they asked me to ask you some questions on behalf of Ohio board members. I just want to thank you for being here. We know your schedule this week must be packed and the fact that you decided to spend it with us, the people affected by mental illness. So I just wanted to start by saying thank you very much. So you started talking about the Veteran’s Administration, and my first question comes from Fred Freise who was a retired captain in the marines also in PG psychology in schizophrenia, and he wanted to hear more about the policies that can be put in place to better serve the nation’s veterans. In particular, make sure they receive mental healthcare and reduce the suicide rate which you started to mention. Could you elaborate on those policies that we should be thinking about?
Well for one thing I would think that if you are a veteran who can’t get access to care we ought to find a way to provide access and ways for the private sector to pay for it, so that you could have a voucher or a card. But you shouldn’t be told “No it’ll be 3 months before we can see you and you have no alternative”. Part of that is to change the philosophy. And to integrate other veterans into the process. We live in an age—think about things you see going on all around you. I keep telling everybody that this is the most important single instrument to public policy: and that’s survey. So imagine for example if we rethought the Veteran’s administration, so that if somebody showed up if they have psychological and social problems as opposed to a purely post stress, then one thing you have to do is figure out the support groups who they get integrated into, so they’re not lonely. And one of the greatest problems you have is isolation. Well, the doctor’s not going to solve that. There’s a great book called Survivor by a Wallstreet Journal woman who had a bone marrow transplant and she goes through this whole process, in the late 90s when all this is primitive and goes through the whole process, and decides she doesn’t like her doctor. Her college roommate was a nurse, helps her sort through her bone marrow transplants (in 3 places) and ends up in Seattle. When she gets done she realizes two things. One is that there are support groups—this 1998-9—support groups for people who went through a bone marrow transplant. Second, she says “if you’re going to have something like a bone marrow transplant, your doctor does not know anything about what you’re going to go through. The doctor gives a bone marrow transplant, they don’t experience it. Who you really need to talk to are survivors who can say ‘ let me tell you what happened to me’”. Well the same thing is true here: there ought to be an instantaneous, same day ability to network people who need care and support groups that day. You can only do that if you use apps and smartphones and devices that allow you to electronically cross distance.
The next question comes from ? Custard who is Director of the Lawrence Taylor Mental Health Center in Cleveland and asks about access to quality accessible mental healthcare. There’s such a dearth of access to care, so what type of measures do you think are needed to increase at the local level the quality and accessibility of mental healthcare?
One of the things that has to happen is with the way government scores costs. So you have a person who would need a complete life. And we talk about this in terms of the example of opioid recovery because the federal government today limits the number of doctors who can prescribe opioid prescriptions on the grounds that it will cost more if the doctors were able to prescribe more. Now, this is a person who—if we can help them lead a complete life, go to work, take care of the family, be a citizen in the community—their main effect is that they are paying taxes, they are engaged and not a blind taxpayer. And this prescription may be a way to invent a better future. It’d be like telling people “we have a new scoring system for your car: changing the engine will be free, but some costs to change oil”. So now set up an incentive plan where you never change your oil until the end of it freezes up and we give you a new engine. And somebody comes along and says, “I’ve got this idea: what if we paid for changing the oil and then we could score it by this new cost” and then he said “well what if we counted the savings and the number of engines we don’t have to replace and say that’s against the budget” and that’s what we are dealing with, this is insanity. What you want to say is “I want the complete cost of the human being who was deprived of the opportunity to pursue happiness and I want the complete income and assets of the human being who was helped to pursue happiness, not when it still would have cost so high in Pennsylvania or Georgia to do the right thing”. And you’re going to find consistently that it is profitable to the government to start with the idea of helping people and then if you toss in criminalization and done being in jail etc..we spend more money on prisoners, than it costs to send them to Harvard. Now as a conservative, I’m not sure I want to send them to Harvard…the general principle, we have all these things going away and I think it requires working groups at the state, federal and local level—but I think a completely engaged person, see what the budget looks like, and then have those kinds of people. Then you would find that an integrated approach that uses technology and that is leaning forward and engaging the total person is dramatically less expensive than what we are currently doing.
Next questions comes from Dr. Patrick Runs, who is a psychiatrist in the University Hospital in Cleveland—you talked about criminal justice and we know that some of the largest facilities now housing people with mental illness are jails and prisons and we know that it is a lot more expensive than it is to treat people in their communities. Could you elaborate on some of the policies that are of great concern to not only you but everyone in this room?
One of the people who blew me away was governor Nathan Deal. We had a one day conference a couple months back, and he came in to speak (and I’ve known Nathan for years, he’s a good guy). His son, is a drug court judge. And his son got him to really understand how counterproductive both in human lives and physical costs the system Georgia had. And he is actually passed 8 or 10 bills now, each of them methodically moving us to a healthier and more rational system. A system that understands the limitations of “ole lock ‘em up’ model”. And Nathan is a remarkable model of someone who can get something done by working at it. We have to start working like him. Now I get very emotional about locking up violent criminals—if you are a racist or a murderer, then you’re a danger to society and we have to have a different plan. But if you’re somebody who is in jail in large part because you’re mentally impaired or because you have been impaired by addiction or some other problem—for us to try and treat you as though criminality is the primary definition of your personality—guarantees that you are going to be with us for the rest of your life. But if we stop looking at how you evaluate each person by the way that probably means that you increase substantially the amount of medical effort in the broader sense of medical in prison or a jail because you actually want a view of the complete person. And so this is a very different approach to how you think of these organizations than we have in the past. One of the things we have to do, and this again is what we are working on and one of the ways to change the whole conversation of opioid recovery, and the sheriffs in particular that were very opposed to opioid recovery as long as it involves a pill or two—as these start to become available through trafficking. And I think if there was a new conversation with the sheriffs so that they know the substantial impacts of them in prisons, then we would have a major all-out effort to help people detox or find some way to manage their lives before they get out of prison because if you just dump them out on the street then they will just wind back up in jail.
The last question comes from Miss Gloria Walker, who is an incredible local leader and advocate and also a…in schizophrenia. And she asked as you know family members provide a great deal of support to people living with a mental illness. How can we better help family members to make sure they don’t burn out and ensure that they have the support necessary to support people?
Like I said earlier, this is something we need to rethink our whole motto. This is by the way a part of the Alzheimer’s discussion. You cannot let the burden fall totally on a family or totally on an institution. So one of the models we can experiment with, which cannot necessarily be used in fifty states—we don’t have an answer that we can just throw out there for the whole country. But can we find models, where for example you could get two days of help a week without the cost of full institutionalization? Part of it requires a really sophisticated diagnostics, part of it would requires really good record keeping (which I think has to be electronic because it’s the modern world and that’s how you keep track of things), part of it I think has to think through—because again every time you start creating an opportunity for money some people can keep, you have to figure out how do you make it so it isn’t just one more skill for the government. But I do think that the greater which we remind people of the goodness of the heart and the love for their family members, to sacrifice themselves, that’s not only financially but also physically amenable. We ought to be looking at blended models that allows a series of interventions without just saying “you’re on your own” or “you need to be institutionalized”.