I recently noted agreement between two credible observers about how power affects people. Robert Caro, the Pulitzer-award winning biographer of President Lyndon Johnson, said in a 2019 interview that he did not agree with Lord Acton’s thesis that all power corrupts. He corrected this to say, “power always reveals.” People with power tend to do what they always really wanted to do.
Michelle Obama made the same observation about her husband in 2012 at the Democratic National Convention. She said in her speech that being president doesn’t change who you are, “it reveals who you are.” I don’t know what the origins of this idea might be, but it seems clear that people with solid credentials on the topic see power impacting people in a way that brings out their strongest beliefs and impulses.
I have never spoken with a president, nor anyone with significant political power. Yet this hypothesis about power makes sense to me, and I see strong evidence for it in the contact that I have had in my career with healthcare leaders. Executives may vary in the extent of their power, but this hypothesis on how power reveals the real person may well hold up for powerful people generally.
What people say vs. what they do
The first step in understanding this topic involves differentiating what people say from what they do. Politicians give speeches. Executives give speeches. Some are better at giving speeches than others. However, what they actually do is far more important than what they say. A leader may tell you that he cares deeply about an issue, and then proceed to focus all of his energy on something else.
I have been heartened over the course of my career to hear healthcare leaders increasingly recognize the importance of behavioral healthcare. This has been especially true in the last decade as healthcare has been reconfigured under the parameters of the Affordable Care Act (ACA). The ACA brought us a new model in which behavioral healthcare was elevated, listed as one of the 10 essential health benefits in the law.
Over the time that federal parity and the ACA have been implemented, funding for behavioral healthcare has fallen far short of the expressed appreciation for its importance. I will highlight another example. I found the concept of the Accountable Care Organization (ACO) to be quite exciting. A patient population would receive care from a local delivery system (often at risk) and have every incentive to achieve cost and quality targets. Despite much talk, behavioral healthcare within ACOs has been largely neglected in favor of funding initiatives to address chronic medical conditions.
The need for collective action
Let me point to a parallel example of this problem, namely, more talk than action, outside of healthcare. Decades of talk about climate change have progressed to the point where we now discuss the climate crisis, yet still with inadequate plans for action. We cannot allow ourselves to stay mired in repetitive political debates. Winning a debate about the importance of addressing the climate crisis is about as important as winning a debate about the importance of behavioral healthcare.
Desperate times call for strong, concrete measures. We need to move forward on the climate crisis with immediate, measurable, and aggressive steps. We need a combination of incentives and penalties. The same can be said about addressing the epidemics of depression, addiction, suicide and overdose. Friendly debates should be over, as well as a tolerance for inconsequential speeches.
We can no longer be fooled by what leaders say, and we must find new and creative ways to highlight their failures to act appropriately. This requires collective action. We need to start seeing our various associations, to which we pay dues, as being more like a union. We need to confront the power structures that keep behavioral healthcare as a second-class issue. It is a primary issue.
One of the more inspiring political alliances that I witnessed in my career was the collaboration of behavioral healthcare leaders (who were often on opposing sides for any issue) pulling together to ensure the enactment of federal parity legislation. This alliance brought together trade associations for psychiatrists and psychologists with the trade association for managed behavioral healthcare companies. The law was passed in 2008 after a decade of lobbying. We need a similar alliance today that focuses on advancing behavioral healthcare as the most consequential specialty for primary care.
Move beyond noble legislation to actual dollars
If the thesis here is that power reveals the real person, power is a prerequisite. The behavioral healthcare industry needs a power boost in the 21st century. That power will derive from funding. Parity legislation and the ACA were tremendous legislative achievements. However, despite parity, a fraction of the need for behavioral healthcare is being met each year. Despite the survival of the ACA, it has been attacked and weakened for many years, and it appears that not all essential health benefits are created equal. They still get funded in lopsided ways in keeping with long established bases of power.
The behavioral healthcare industry should focus on increasing overall revenue. While this is an easy challenge to make, most of the people reading this are individuals with a specific role in the industry. We spend most of our time focused on that role. However, the field will never advance if we just focus on our day jobs. We have specific roles, but we will ultimately rise or fall together.
We need an industry alliance that establishes annual targets for behavioral healthcare revenue. This should include all sources of revenue, from private to public, and the alliance should be based in Washington, D.C. Powerful legislators should be recruited to push our agenda forward. We have parity and ACA due to powerful legislators.
Our message is simple. Behavioral healthcare is a critical healthcare specialty that is significantly under-funded, contributing to thousands of needless deaths every year, and we need a campaign to raise the level of funding incrementally every year. No source of funding is exempt from this campaign. The alliance will have experts targeting each segment of behavioral healthcare for revenue increases. It should be approached as the healthcare crisis that it is.
Let me finish by returning to power. Lyndon Johnson deeply cared about civil rights, and he showed the country the depth of his commitment once he became president. The healthcare industry has many leaders who espouse support for behavioral healthcare, but their failure to take meaningful action means they have revealed their true selves and so we must move on. Let us promote genuine advocates from within our ranks to fix the crisis in behavioral healthcare.
Ed Jones, PhD, is senior vice president of the Institute for Health and Productivity Management.