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Donald Berwick, health reform advocate who heads the Centers for Medicaid and Medicare Services, keynoted San Diego's meeting of the National Council for Community Behavioral Healthcare.

Berwick began his address with an example from his medical practice as a pediatrician in Boston, when he treated a poor teenager who became a "medical miracle" in remission from leukemia. But depression and intermittent drug use led to his death 10 years later. "For a pediatrician in that setting, behavioral health and health care are absolutely wedded," he said."There is no possible distinction between the two."

With optimism that the Affordable Health Care act can be a toolkit to end fragmentation, he described goals for a seamless system that will end uncoordinated practices costing patients and the public too much. The medical costs for people who have diabetes and depression are more than for people without depression.

How to meet the needs of the 9.2 million people with dual eligibility for Medicaid and Medicare, and who comprise 40% of Medicaid costs is the type of challenge Berwick faces. New programs for innovation have been announced through CMS aim to unify segments that otherwise lead to error, injury and reduce life expectancy.

The toll of mental illness can be seen in a reduced life expectancy. Average life expectancy for people with a mental illness is currently 56 years compared to 78 years for people without behavioral health needs.Spending cuts or block grants, he said, will not promote health or a partnership with the federal government that is essential for a system for organizing responsible health care.

Corrections: YouTube added 5.03.11

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