FULL EVENT RFK Jr speaks on mental health addiction

A little harder than you expected coming through security and the QR code and the firearms screening and everything else, but at least most of you made it through and made it through on time. So thank you so much. We have a very tight schedule today. We're packing in a lot in a short time. We have the three leading administration officials in our nation on health care who are going to be presenting to all of us today, and it's a real honor that one of them is my cousin, Secretary of Health and Human Services Robert Kennedy, and he will have a great deal to say because as many of you know, just last week President Trump issued an executive order on tackling addiction in this country, and I don't think it was any accident that that order was issued because for those of you who follow a little bit of my cousin Bobby's campaign in the presidential election, he made addiction really a forefront of his whole campaign. If you haven't, just Google the YouTube, RFK, Making America Facing Addiction, and it's all in there. And I was so impressed because I had never seen a presidential candidate devote so much of their time on the road to this issue, and Bobby crisscrossed the country and met with many of the people that you and I know, the kind of thought leaders in addiction treatment, those that are really advocating for better prevention, and finally, what's often left out of this equation, those who are supporting recovery. Because we in this country have an acute care system that continues to treat people that never supports them in terms of their longer term recovery, and even though this is a chronic illness, we often treat it as an acute episodic illness as opposed to the chronic illness that it is. What was really impressive to me in that documentary and the words the Secretary's had since then is the frame that he's putting around this issue, because he and I both understand what it is to be in recovery, and we know that it's a biopsychosocial illness, and what we've neglected in our treatment paradigm in this country is the psychosocial, but principally the social. We have done a terrific job on the biological, we know what to prescribe, thank God we've got some not only great treatments in the past, but ones that are coming on board that show great promise, but if you don't combine the mental health and the social health, it's like a three-legged stool, the stool's going to fall down. And what I read into the President's Executive Order the other day is a commitment to start connecting the dots. All of us in our movement know that we're so fragmented, all of us as advocates advocate for one little diagnosis, or one piece of the treatment continuum. We never take a holistic approach, and furthermore, we never connect all the different government agencies that touch someone with these illnesses. We relegate them to one system, and that's the healthcare system. And we've forgotten that these people work and operate within all the housing, and tragically and too often the case in the criminal justice system, and the human services system, and so forth, and what we've never done as a country is think about the true cost of these illnesses across the government. We only look at the cost to the medical spend alone. And until we take a broader aperture of this, we're never going to wrap our arms around all the needs that someone has, such that we can provide them the support that's going to give them the best chance at long-term recovery. Now in this audience I see many friends who are there for Amy and I, furthermore, let me acknowledge my wife Amy Kennedy is over here in the back. Amy and I co-founded the Kennedy Forum shortly after I left Congress, and the main goal of the Kennedy Forum was to really push for the full enforcement of the Mental Health Parity and Addiction Equity Act, and to end the double standard in our healthcare system that treated the body but neglected the mind, that treated the physical but neglected the mental. It's hard to believe that that has been the case throughout our history, and frankly we still need to fight that battle. But as you know, we at the Kennedy Forum have also taken on the Alignment for Progress, and in the Alignment for Progress we're not only advocating for more access, meaning payers reimburse for care, but we're also advocating for outcomes. God forbid we would ever want to pay for something that actually has better outcomes. And so the idea is the alignment. We have to align the reimbursement to pay for the treatments that actually show the greatest results. Not a rocket science here, but certainly a paradigm shifter if you think about our field, because all we do today is pay for services. Did you make your therapy checked? Did you make your check? We don't check how people are actually doing in their lives. Are they stable? Have they been able to hold down a job? Do they have housing? Are they reconnected with their family and friends? Are they in the community? These are things that have never been done in our system, and one hope that I have through Secretary Kennedy's whole initiative is that we can start to connect all of these dots that have been left aside in the whole approach. But the Alignment for Progress today is getting new life, and it's getting new life through the action for progress, because we at the Kennedy Forum have put great, you know, policies forward, and we needed to curate those policies, but at the end of the day we need to also implement those policies. And I am so grateful that I met an old friend who I reconnected with in Tom Kousompas and found out that he has done at his firm Health Spirit exactly what we want in mental health and addiction. He revolutionized the end of life care to ensure that we had a bundled payment model that pays for outcomes for the whole person. And frankly, for those of us who are advocating for addiction and mental illness treatment, we want a bundled payment model. And Tom and his A team at Health Spirit have wrapped themselves around our initiative at the Center for Behavioral Health at Health Spirit. Many of you have been partners for us in that effort, but I just can't thank Tom enough. And I'll just conclude with this. You know, many of you may wonder, you know, what am I doing up here with someone that I share in common very little with politically? And I'll just answer that by telling you a story. You know, in the years since I left Congress, I took up the fight against commercialized marijuana, and I fought sports betting and the problems with gambling in this country, both of which are new addiction for profit industries that are really compromising the health and well-being of our fellow Americans. And guess what? Fox News used to love having me on. They used to love having me on because I was like a Democrat that talked against marijuana. They said, we've got to have that guy on here. So I went on all the time. What always surprised me is when I got off Fox News, and of course I would check my phone for messages, my phone lit up. And it was all my fellows in recovery. And I'm thinking to myself, that many people in recovery are watching Fox News? So it was a real awakening for me that we really can't be divisive in this issue. We have to be unified, because as much as we have our political disagreements, this is an issue that affects every single American, as the Secretary has said. And I really appreciate the fact that he has taken his role as HHS Secretary to put this on the spotlight. And so with that, I'm going to have my friend Tom Kousompas invite the Secretary to have a fireside chat around all of these issues and the new initiatives that have just recently been announced. Thank you so much, Tom. Well, Patrick, before we have the Secretary on, I just want to say one thing. First of all, welcome to all of you. We're all here because of your leadership. So I think we want to give Patrick an extraordinary round of applause. He has brought all of this together for us to focus on and make a difference. And now we're going to welcome the Secretary of Health and Human Services to the stage. Welcome, Secretary Kennedy. Thanks a lot. Good to see you. Good to see you. Well, thank you so much for being with us at our launch for Action for Progress. This is such an important issue. As you and I have talked and you've said so many times, mental health, behavioral health, addiction is really one of the most critically important issues in our health care today. And it affects families throughout the country, all parts of families, mothers, fathers, sisters, brothers. It really is so extraordinarily important. And I know how important it is to you. And so we're so grateful for you to spend the time with us today, but also I think to hear from you about why it's important and sort of where we're going with the exciting new announcements that you made just recently around the executive order and the focus that you're taking to address these issues. Talk to us about that. I mean, it's just a raw financial issue. It can be reduced to a raw financial issue. It costs about $92 billion a year in direct costs, about $890 billion a year in indirect costs and lost productivity and cost to our health care system and just collateral damage and all the collateral illnesses. But one of the things Patrick and I were talking about backstage is the intensity of use by drug addicts and alcoholics of the health care system. They, you know, they're in the emergency room all the time. They're also imposing costs on our justice system. They're imposing costs on our foster care system. They're, they overutilize every aspect of the government and you get them into treatment and all that stops. And they stop, you know, Patrick was telling me that he had, he went to 17 rehabs and, but he was in the emergency room once a week with, you know, everything from kidney infections to contusions on his face from falling. And in 15 years that he's been sober, he's never been to an emergency room. And, you know, I see that, we all know that that's what happens to addicts. They're, they're negative producers and they're just, like I said, in economic terms they're drags on the whole system. But also just for the morale of our country, we are in, what we're facing now in this country is we have the worst health outcomes in, in the history of the world. The highest chronic disease burden of any country in the world. We pay the highest cost two to three times what Europeans pay for health care. And we lost six years to Europe in terms of our lifespan over the past two decades. We've, we've got the highest infant mortality rate in the developed world, the highest maternal mortality rate in the developed world. And then our, you know, cancer rates, we're having an epidemic of colorectal cancer now among children. And 10 to 14 year old children, the last decade of colorectal cancer has grown by 500%. That is, you know, we have a health care crisis, but we also have a mental health crisis. And that's a crisis of loneliness, a crisis of despair, of fragmentation, of atomization, of just disconnection from community. And it's being amplified by social media, by cell phones, but also people when they're disconnected turn to drugs. They look for something outside of them, fill that lonely hole inside them. And so, you know, you're seeing record numbers of addictions now. The highest cause of death overdose is in children under, in Americans under 45 years old. And we have, we can't fix that by treating the addiction alone. You have to treat the, the, the, the, the causes of it. We have to work on prevention. We have to intervene early, but we have to figure out ways to reconnect, particularly our children with community. Addiction is about isolation. It's a disease of isolation. Addicts end up alone. They burn their relationships. They lose their jobs. They end up in rooms or jails or institutions or dead. And the ultimate solution to that is reconnecting people to community. Responses, you know, there's no coordination between all of the needs and the institutions that could help with this problem. Housing and law enforcement and health care and mental health care, there's no coordination. And it's a fee-based service system of people are, just like the medical system, people have an economic incentive to make sure you don't get well. And that's not saying people who work in these, you know, in, as caregivers don't want you to be well. Of course they do. But the system itself is designed to keep you sick. Every time you relapse, the rehab makes more money. And the costs go up and the insurance companies, you know, you think the insurance companies are going to lose money every time you go. But they are looking at the entire cost because they collect friction from those costs. It's like Lloyd's and London would rather have one boat sink a year or 100 boat sinks a year. They'd rather have 100 because then everybody is buying the insurance and the cost of the high goes up and they're collecting friction on it. Everybody along the way is making money on fee-based services. And ultimately what we have to do at HHS over the next three years is do everything we can to switch the model at CMMI and CMS and HRSA and SAMHSA to coordinate response so that somebody is in charge of that addict. Somebody is accountable as he moves through the system. And to move to outcome-based services where people have an incentive to make sure you don't relapse, that there's a strong economic incentive. You get paid one price for treating that individual and you follow that individual for three years and you're responsible for all the costs. That will bring down the cost because then people will look. We have lots of evidence-based treatments. We know what works. We're not doing it well because nobody has an incentive to do that and so there's no accountability. And we were talking earlier as well, Secretary, about the disconnect between the sort of mental health and the physical health. And as you've just described, the opportunity to make sure that all of that is incorporated in as people are cared for so it's not just separated. But how does the mental health affect the physical health? And so that there's actually an integration of services. Yeah. I mean, we need to integrate services. The Great American Recovery Act is an effort to begin that transition. The STREETS program, for example, is based partially on the program that was modeled in the Netherlands. We go out, we bring together law enforcement, we bring together mental health, we bring together counselors, we bring together housing and we intervene early. We try to get to that addict as soon as or people with mental health problems as soon as possible. We find them on the STREET. We move them from crisis to detox to treatment to housing to employment and ultimately to connecting, reconnecting to communities and to self-sufficiency. Well as you can imagine, everyone here is very excited about the Great American Recovery Initiative and so hearing more about it and understanding how you're taking this on and moving it forward is really extraordinarily important and very exciting to all of us who are concerned about these issues. You had talked about the STREETS program. Tell us a little more about STREETS and then sober housing I think is also a very important part of this that I know you're very committed to as well. I mean, the STREETS program begins with a $100 million program that's going to be distributed to eight pilot programs, regional pilot programs, where we will coordinate the government. Insurance companies don't have any. The insurance companies, your life with them is very short-lived. You move from one to the other. They're looking at the cost over one year and we need to extend that periphery of that horizon so somebody is looking over the cost over three years and the entire cost. Right now the fiduciary for addicts is CMS. CMS only is looking at the cost savings to the health care system. That's all they're concerned about and nobody is looking at the cost, the broader cost savings. For example, law enforcement. We're bringing all of these agencies together. We're going to do a study that looks at the entire cost of the addict over the lifetime of the addiction so that we can demonstrate savings over time to justify the cost of this program. The STREETS program, as I said, it's a $100 million program. It builds on a $45 million program that we gave this year for sober housing. I'm working with Scott Turner at HUD to revolutionize sober housing. I'm a really strong believer in sober housing. I think we need to not just treat the addict and then put him back in the environment that was making him sick or contributing, let me put it this way, contributing to his illness. We need to give him some stability or her some stability and from there they can get employment, they can develop relationships, they can develop independence and then they can move on. You need to give them that. Without sober housing, treatment is going to fail. This is a whole new approach, as you're describing, which is also so tremendously important and the difference between other programs from the past and sort of where we're going into the future under your leadership. It really is a very important and exciting part of this. We'd also talked a little bit about integrating some faith-based initiatives within this whole arena to help sort of address these issues. Talk a little bit about your thoughts about that and how that plays a part of it. Faith-based initiatives work and that's, you know, they're scientifically proven to work and they do that by, again, by reconnecting us to a community, by expanding the relationships that the addict has. As I pointed out, addiction is a disease of isolation, cut off those relationships and God talks to human beings through many factors, through each other, through organized religions, through the great books of those religions, through wise people and the prophets and through nature. Nowhere was such texture and grace and joy as through other human beings. When we cut off our relationships with other human beings, we lose that access to the divine and that is a healing power. We are in a spiritual malaise in this country and we need to give people access to all different ways of reconnecting with something that is higher than themselves. You know, I'm reminded of Bill Wilson who is the founder of the 12-step movement. He was in a program before he launched AA which was called the Oxford Group and the Oxford Group had eight steps from which the 12 steps of AA are taken. Those eight steps were intended to induce a spiritual awakening and Bill Wilson had that spiritual awakening and his compulsion to drink, which he'd been fighting for 40 years, suddenly just went away, just miraculously and he could not imagine that he would ever take a drink again and then during that six month period when he was sober, he put together a deal to buy the primary vendors for the Goodyear and fire some tire companies and the deal was going to make him a millionaire and set him up for life. This was the height of the Great Depression, 1932 and he went out to Akron to ink the deal and somebody else had gone in and stolen the deal from him and he had put all of his finances in that deal and he was crushed. He was standing in the lobby of the Mayflower Hotel in Akron and all of a sudden, all of that compulsion to drink came back to him full force and he was 20 feet away from the lounge and he could hear the ice clinking in the glasses and he could hear the laughter of the patrons and it was screaming at him to come in and get a drink and on his way to the lounge, he had the central revelation of the 12-step program, which is he realized the only way that he was going to stay sober is if he helped another alcoholic and he went, instead of going into the lounge, he went into a phone booth and he got the yellow pages and he looked up preachers, Salvation Army, sanitariums and hospitals looking for a hopeless alcoholic that he could talk to and he eventually found Bob Smith, Dr. Bob Smith, who had tried everything to quit drinking and he was able to persuade Bob Smith to meet with him and when Bob Smith came into the meeting, he said, you got 15 minutes because he heard it all. He never heard it from another alcoholic and they ended up talking all night and that was the first 12-step meeting and they both decided the next day the only way they were going to stay sober is to find another alcoholic so they went to the hospital and they found a guy who was literally handcuffed to a bed and he was the third member and it was that, this realization that the only way that the spiritual awakening works, but it's just a daily reprieve and if it's not renewed every day through service to other people, service to other alcoholics, then you'll lose it and so the 12-step programs teach you, build that muscle of you've got to do something to serve another human being every day of your life and that's how you teach people to reintegrate in the community because they get that spiritual and emotional return from the service that they then become addicted to and they begin building relationships and friendships and a sense of community and stability in their lives and it gives them a purpose in their lives and that's how you cause, that's how you precipitate a spiritual revitalization, a spiritual renaissance, reaching out to addicts on the street and then giving them stable lives and teaching them the ways to be of service every day. It's extraordinary. Well, this also is, you know, we as a nation have a crisis around social isolation and loneliness and I think that adds, as you've just described, to these issues around addiction, et cetera, that are so prevalent, but the opportunity to reach out, as you've described, is extraordinary and yet so simple to do. I don't think it's simple. Simple in terms of making the effort. I get very intimidated from talking to Patrick. Yeah, right. In the encyclopedia. Simple in that you have to make that effort. He has all these ideas about how to do it, but it's all involved, you know, doing these, a lot, a lot, it seems like you've got to change, you know, everything the federal government has been doing forever and I think that's what we have to do. Which I think you're able to do. We can do that. You know, we have to, there's a tremendous amount of low-hanging fruit and, you know, but I'm hoping that when I leave this job in three years that we will have changed the trajectory and changed public attitudes toward the treatment of addiction and, you know, and at least developed a lot of models in the states for outcome-based care and for integrated care so that we have something to build on. Yes, yes. And that's happening so much, as you know, in the physical health arena. So paying for value, incorporating all of those aspects. That's what we're trying to do across CMS and we have an amazing team. Dr. Oz is really extraordinary and he's completely committed to this as everybody is, you know, Marty McCary and Jay Bhattacharya and all the people who work there are being committed to that model. Yes, well, and the outcomes then will be quite different than they are today where you're just paying for a service. Yeah, and that's just a death spiral for us. Death spiral, yeah, yeah. We have to figure out ways to reconnect our children to, you know, a national purpose and to communities and to a sense of purpose in their lives. Yes. And create bridges to bring people together again across all these atomized landscapes. Right. You know, one of the challenges I think that we all face as well as the workforce, the opportunity to provide these services depends on a robust workforce. What are things we can do to support developing a better, a more comprehensive workforce? Because right now we have a lot of shortages and problems that really prevent us from doing certain things. You mean in caregiver addiction specifically? Yes. I mean, that's part of, you know, the funding that we're putting in. We're putting in hundreds of billions of dollars. Right. And a lot of it, about half, about $500 billion will go to the states or in block grants. And, you know, that is, a lot of that is workforce retention, building a workforce. Oh, it's, you know, we're, that's one of the things that we've got to make an investment, an enormous investment in. Yes. You know, and I know we've talked about this before, but I know that personal stories are so important with respect to these issues because people relate. And I know your personal journey has been so extraordinarily important. Could you talk a little bit more about how that's affected where you're thinking and sort of what direction we're going in as a result of what you've experienced personally? Because I know that has really shaped your approach and your value. Yeah. I mean, I was a heroin addict for 14 years beginning in my early teens. And I've been 43 years in recovery. And these, you know, 12-step programs saved my life. My, all, it provides all the gravities around which all of my life is oriented. My family, my friendships, my, the work that I do. And I, I mean, the, I go to meetings every day. I don't have time to go to meetings. I've got 75,000 employees and I've got a big job and a lot of people are relying on me. And I really don't have time to do it, but I go anyway, no matter what. And when I first came into the program in September of 1983, my first meeting, I asked the guy, how long do you have to keep coming to these meetings? He said, just keep coming until you like it. Until you like it? Yeah. And I, I've been coming 43 years. I still don't like going to meetings. There's always some place I'd rather be. I'd rather stay in bed with my wife. I'd go to an early morning meeting. And, but I go every day because when I go, the rest of my life works. And for me, it's like brushing my teeth. I don't, you know, I don't look forward to brushing my teeth. I don't enjoy the sensation. I do it every day because I don't want to live with the consequence of what happens when I don't do it. And I need, need to maintain that, that spiritual center. Everything that I've done in my life, that I've done out of personal ambition or aspirations or an acquisitive impulse or, you know, materialism, has been wormwood and bile. And everything that I've done that is consequential or enduring has come from that spiritual center. And, you know, we're all, we're all hybrid beings. We're half spiritual and half biological. And a lot of times our biological being is, doesn't have the best judgment. And the challenge is how do you walk with one foot in the spiritual world and one in the biological world? And the answer to that is that you have to be disciplined about keeping yourself spiritually fit. And so I, I make a big effort to do that in my own life. But I also, it gives me an understanding about what that takes to, you know, for an addict who's out there, who's hopeless, who's irritated, discontent, who has no, who's lost all of their touch with their own humanity. And how do you bring them back into society? And how do you give them a chance to fulfill their God-given potential and give them a sense of purpose in their lives? And, you know, it begins with these little steps of giving them the opportunity to be useful to other human beings. You know, the other area that you've mentioned oftentimes is the importance of prevention. Working to make sure that we can prevent these things from developing into the crisis points and crisis response as well. Any thoughts about that? Yeah, I mean, the longer, this is just like in physical medicine, the longer you wait, the more expensive and the more insurmountable the job becomes. And when you, you know, we know the kids who are going to become addicts. It's pretty easy to identify them early in life. They're acting out. They're having contact with a criminal justice system. They're getting thrown out of schools. They're getting in fights. You see these things happening, and we need to start doing the interventions then. And there's still neuroplasticity in the brains before they've internalized the pathology and locked themselves into behaviors that are almost, that are very, very difficult to break later on. But we can break them early if we identify them early. And, you know, that's one of the issues, one of the aspirations of the STREET program, to find people as early as possible, but also we're taking a number of other steps to make sure, you know, to identify kids in foster care who need help and provide them with help before they have encounters with, again, with the criminal justice system, with hospitals, with medical care, et cetera. So as you look ahead, Secretary, thinking about the future, in five years in America, what progress do you hope you'll see as a result of this work? How do you see that progress moving forward? Well, you know, I'm hoping that we've at least by then gotten a series of models around the country and in states and cities of things that work so that we know how to do them. We know how to bring the insurance companies in. We know how to do early intervention. We know how to unify the response across all the different agencies. And we know how to, we've developed ways of following the addict for several years and having somebody take ownership of that addict and say, okay, if I pay you as a rehab, I'm not going to pay you, you know, a daily rate so that the guy relapses in two months and you get paid again. I'm going to pay you one cash disbursement for him for a year or for two years or three years. Yes, and really manage the care. Right, and you manage all the care. Yes. You're responsible for that individual. So if he shows up on your doorstep again, you're going to lose money. Right, right. And that gives the economic incentive, financial incentive to that rehab to do everything in their power to make sure that that addict does not return. And when you align the economic incentives with the healthcare outcomes that we're looking for, behavior will change. And that is what we need to do. And that misalignment, you know, is pervasive throughout the healthcare system in this country. And that's why we're paying so much for healthcare because people are not getting paid to make patients well. Everybody in the system, the insurers, the hospitals, the doctors, the pharmaceutical companies are all making money by keeping us sick. And, you know, those economic incentives filter down and they change human behavior. And we're not going to do anything without, the easiest way to change behavior is to rationalize the financial incentives. Once you do that, everything else is just going to follow naturally. People are going to be incentivized to identify the interventions that actually work. Yes. And to implement them. And the companies that don't do that are going to go out of business. The companies that do are going to stay in business and flourish. All the things that we're chattering about, nothing's going to work unless we realign those incentives. It's absolutely critical that we do that. So we all have our thinking caps on every day about how do we do that? How do we do models for this? How do we, you know, how do we, how do we rationalize the economic incentives so that they're aligned with good healthcare policy and good health? Yeah, well, that's, you know, I think everyone in this room and certainly the work we're doing for Action for Progress under Patrick's leadership is really focusing and aligned with exactly what you're saying. So we are really grateful to you for your leadership and grateful that you're moving forward with all of these initiatives that we can work with you on and be supportive of and really transform the mental health addiction care that we provide in this country. It really is an exciting opportunity. Thank you very much, Tom. We're about out of time. I just want to say one personal thing at the end. The Secretary and I have known each other for, I don't know, most of our lives, actually, since we were kids. At least 50 years. When I was talking about doing this, my colleague said two things. Don't call him Bobby and don't start talking about Hickory Hill and Hyannis Port stories. So we stayed away from all of that. But what we didn't talk about and we touched on was I think the thing that I find most inspiring by this whole discussion, Secretary, is, one, your passion and commitment to transforming the system and providing that leadership. But also if you think about those who are suffering today, right now, struggling the way that you did in the past and looking at sort of that time to where you are today as the Secretary of Health, influencing the health of millions of Americans, the inspiration and hope that that provides is beyond description. So thank you for all you're doing. We look forward to working with you into the future to achieve these extraordinarily important goals that you've aligned. Thank you very much, Tom. Let's give the Secretary a round of applause. You're the best. Give me a hug, man. Thank you. Well, that was really an inspiring conversation, important for all of us to think about the future, where we're going, and how we need to get there together in our action for progress. So I'm also now pleased to bring on stage CMS Administrator Dr. Mehmet Oz and Dr. John Sharon, professor of psychiatry at UCLA and USC and the former director of the L.A. County Department of Mental Health. So with that, welcome to the stage, and I'm going to turn it over to you guys. Thank you, John. Thank you, Dr. Oz. Thank you.