At the annual State of the Union spectacular, and during the ensuing week, all the players—the President, most Representatives and Senators who popped up and down on the House floor, governors of both parties, even some of the left (MSNBC) and right (Fox) wing talking and shouting heads—recognized that federal and state government deficits had reached Red Alert status and called for bipartisan measures to reduce them.
But, as fast as you can say Nancy Pelosi and Scott Brown, they said that seeking common ground on what to cut made finding the needle in the haystack a piece of cake.
Well, here’s something I believe all Americans—right, left, center, Tea Party conservatives and liberal Democrats—want to reduce: substance abuse and addiction. That’s where our political leaders can join hands in the march to deficit reduction. It’s an opportunity to cut sharply the more than $500 billion taxpayer dollars for FY 2010—11 percent of federal and state budgets—that governments spend on tobacco, alcohol and other drug abuse and addiction, almost entirely to shovel up its consequences.
To me, the most disappointing characteristic of State of the Union week is that neither President Obama, nor any member of Congress or state leader, mentioned the potential savings—in health care, prison costs and social programs (to say nothing of human heartache)—from reducing substance abuse and addiction in America. It’s like a bevy of obese men and women who claim they want to lose weight but refuse to get off the couch.
Of the $345 billion in federal government spending on substance abuse and addiction, 97 percent—$334 billion—goes to shovel up the wreckage of such abuse and addiction in Medicare, Medicaid, federal prisons, special education, child welfare, income assistance, homelessness and other programs. That’s about nine percent of the entire federal budget. Medicare and Medicaid take the biggest hit—some $248 billion—with Veterans and Indian health programs taking a hit of some $15 billion. When the President and Democratic leadership say they still want to reform health care, it is hard to understand why they propose little or nothing to prevent alcohol and other drug abuse.
Governors complain that Medicaid and prison costs are strangling other programs and putting their states on the cusp of bankruptcy. The howls of California governor Arnold Schwarzenegger and New York lieutenant governor Richard Ravitch about Medicaid and prison costs can be heard across the nation. Yet there is little stomach in the states for dealing with the chief culprit.
Substance abuse and addiction account for $63 billion of state health care budgets (almost 30 percent) and are major contributors to 80 percent of the funds states spend on prisons and criminal justice. Ninety-four cents of every dollar states spend on tobacco, alcohol and other drug abuse and addiction goes to shovel up the wreckage, most of it in health care and criminal justice costs. As is true for all patients with alcohol and other drug problems, Medicaid beneficiaries with substance use problems account for a disproportional share of Medicaid spending. Eight of ten felony inmates have alcohol or other drug abuse or addiction problems, committed their crimes when high, stole money to buy drugs, violated the alcohol or drug laws, or share some combination of those characteristics.
So, Mr. President, House and Senate Democratic and Republican leaders, and Governors of every stripe, do something every American will applaud: march arm in arm to mount aggressive public health programs and provide evidence based treatment to combat alcohol and other drug abuse. We know from the changes in our people’s conduct about smoking, AIDS and seat belts that such a public health campaign can work. We know that many treatment programs have higher rates of success than many expensive cancer therapies. And most important for our troubled democracy, we know our citizens (and the world) are anxious (even desperate) to see you politicians join hands in a common cause that will reduce government deficits (and tragedies for millions of families).