Dr. Keith Humphreys

The challenge on the public side will be the contraction of Medicaid.

So the budget bill that was passed this last year takes about a trillion dollars roughly out of Medicaid over the coming years.

And a number of people on Medicaid have substance use problems.

how they will get substance use care and other care that they need is not entirely clear.

So I'm quite worried about the impact of that, especially on low-income Americans who are dealing with addiction.

It is not irrelevant that those programs were designed by people who have the problem and therefore understood what it is, what you need when you've got that problem.

So I think about this like where I am in Palo Alto.

Let's say some engineer wakes up in Palo Alto on a Saturday morning with his 20th or 30th or 40th beastly hangover of the year.

and says, you know, what am I doing, you know, I've got a great, you know, I've got this great life, I have this, you know, $200 million one-bedroom condo that I really like and, you know, I'm messing up my life, alcohol, let's call Stanford, psychiatry department, okay, and try to get some help.

Well, they're closed on the weekend, you know, you'll get a message, then on Monday you can call back and then you'll get on a waiting list and eventually you might get in.

So for a condition characterized by ambivalence and impulsiveness, I want to quit now, two hours later I don't, that's like this healthcare system is the worst possible design.

Whereas, how is AA designed?

Be like, I'd like to go to AA, you go on the AA website, look in the area, oh my God, there's like 15 meetings today.

And not only are there 15 meetings, but there's like a woman's meeting, a men's meeting, you know, a spiritual focus meeting, you know, a LGBT meeting.

and you can just go and that moment you have at this moment I want to change, you can just follow through and then you can get immediate reward, social reward for taking positive steps towards it.

The treatment system will never be that good

at sort of being that accessible.

And of course, no health insurance, no paperwork, no pre-approval.

That's amazing.

Does it actually work when people get there?