It was all hands on deck for the White House Summit on Health Care last month.

The summit, hosted by President Barack Obama, included representatives from almost every interest group with a stake in his goal of revamping the nation's health care system.

Attending the day-long event at the White House were physicians and allied health care providers; payers; representatives of patient advocacy organizations, business, labor, and academia; and a who's who of politicians, as well as a number of "everyday citizens."

The summit opened with an address by the president, who said the nation could no longer wait to fix its health care system. Five breakout sessions followed.

Among those in attendance was AMA President Nancy Nielsen, M.D." Improving the health care system for patients and physicians is a top priority of the American Medical Association, and I am honored to join President Obama as he works toward reform," Nielsen said in a statement." His inclusion of physicians in the summit emphasizes the critical role [that] those who provide health care play in the reform effort."

Nielsen also used the occasion to hail the president's budget, released the week prior to the summit (Psychiatric News, March 20). "We are hard at work to ensure that physicians can continue to care for seniors, and the president's budget took an important step toward achieving that goal by including $329 billion to stop Medicare physician payment cuts," she said. "Looming physician shortages and aging baby boomers highlight the urgent need to permanently fix the Medicare physician payment system to preserve seniors' access to care."

The list of attendees also included William Emmet, director of the Campaign for Mental Health Reform, a coalition that includes APA.

"I think the president was able to get practically all of the stakeholders from both sides of the aisle and both chambers into the room," Emmet told Psychiatric News. "From a political standpoint, I think what he was trying to do was remove any possibility for anyone to say they weren't part of this process."

Emmet was a panel member and speaker at one of the five breakout sessions." My message was that you can't really have comprehensive health system reform if you don't understand how mental health and substance abuse are interwoven with general medical health, and that the consistent failure to address those issues drives costs up."

In the midst of a dire economic downturn, much attention is being paid to the ever-increasing costs of health care, Emmet said. "One of the best arguments for mental health advocates to make is that one way to address the costs of the health system is to properly address the mental health needs of Americans," he said.

Emmet believes that the prospects for health system reform are "more positive than negative." He observed that most people today are receptive to the idea that adequate treatment of mental illness and substance abuse should be part of any kind of reformed health system.

But much at this stage remains uncertain. "Certainly the members of Congress working on this recognize in some vague way that mental health needs to be a part of it," he said. "But I don't think they understand how mental health issues are interwoven into the broader health issues.

"The question is whether we in the mental health community can be successful in demonstrating and educating people to the fact that mental health really is integral to general medical health."

The political and other obstacles confronting the president were evident even at an occasion, like the White House summit, devoted to good intentions. Emmet reported that toward the end of the day, Sen. Charles Grassley (R-Iowa) expressed to the gathering his serious reservations about proposals to expand the federal government's role in health system reform, saying options proposed in such plans would act as unfair competition for private plans. (The president's plan, as outlined during his campaign, includes an option for people to enroll in a publicly funded health care plan.)

The president responded that the public option would in fact force private insurers to raise standards. "So there was obviously a debate starting right from the beginning," Emmet said. "Grassley was raising an issue that a lot of Republicans are concerned about."

Information about the Campaign for Mental Health Reform is posted at<www.mhreform.org/>.▪