As Congress enters the final stages in preparation of national health reform legislation, it is imperative that we not become “sheeple—people who behave like sheep. Acting like sheep—impulsively, unthinkingly, herd-like—will stand in the way of the bold and thoughtful steps we must take to achieve good health reform legislation that effectively includes mental health and substance use care and prevention in the package. The “we” refers to each of us who has made a commitment to the mental health and substance use fields. Now is the time to act!
Several important reasons, already known to most of us, underlie the need to enact national health reform:
• Fully one-third—one-third!—of uninsured adults have mental or substance use conditions, or both.
• Less than half of those with mental health conditions and less than one-fifth of those with substance use conditions receive any care at all.
• Mental and substance use conditions are major risk factors for many severe chronic illnesses—asthma, diabetes, and heart disease.
• And, most disconcerting, public mental health clients die 25 years younger than other Americans because they do not receive appropriate primary care.
Together, these facts present a very troubling picture of our current health care insurance and delivery system. The road to passage of a final national health reform bill is difficult at best, with many potential hazards and potholes along the way. The process encompasses many different bills (at present) and has many steps: • The Senate Finance Committee is marking up a draft national health reform bill, and the Senate Health, Education, Labor and Pensions (HELP) Committee has a proposed bill ready to go to the Senate floor. These two bills will need to be melded.
• The House of Representatives is ready to meld three slightly different bills into a single bill and bring it to the House floor. (The House Ways and Means Committee, the Energy and Commerce Committee, and the Education and Labor Committee each passed the America’s Affordable Health Choices Act of 2009 during July and each subsequently marked up the draft bill.)
• At each stage of the mark up and after introduction on the floors of the Senate and House, amendments can be added to a bill.
• Once the Senate and House each debate and vote to approve a bill, the two bills will need to be reconciled, and then the Senate and House will each need to vote again on the reconciled bill. Of course, at any point, different reform features can be added or deleted.
This complexity makes it essential that we monitor the entire process in the Senate and the House from beginning to end. In response to the loud debates that occurred over the summer recess, the Whole Health Campaign conducted a briefing for staff from the House of Representatives on September 9. The goals of the briefing were straightforward:
• reinforce the case for national health reform and the inclusion of mental health and substance use care and prevention;
• document that mental health and substance use conditions are preventable and treatable, and that appropriate treatment can lead to cost-offsets; and,
• show that the mental health and substance use communities are fully supportive of national health reform.
This briefing was conducted by Kirsten Beronio (Mental Health America), Mady Chalk (Treatment Research Institute), Eric Goplerud (George Washington University), and me. Currently, the Campaign is planning a similar briefing for Senate staff.
In all likelihood, the present effort to effect national health reform is a once-in-a-lifetime opportunity for each of us. I also am sure that we don’t want to be remembered as the generation who failed at reform. Hence, it is imperative that each of us Listen-Focus-Act on reform.
Listen: This is crucial for two key reasons: First, some aspects of reform are very subtle, so it is quite easy to miss important content and process features. For example, the specific insurance coverage/co-pays/deductibles being proposed for the newly insured poor are exceptionally important. These need to be compared with those of employer-sponsored plans to determine whether we are actually achieving parity. Second, specific proposals change almost daily, sometimes dramatically, sometimes only slightly. For example, the Senate HELP Committee Bill already has several hundred amendments.
Focus: This implies being strategic: What actions are other groups taking with respect to their Senators and House Members? Can we partner with them? Does an opportunity exist for a first page article (or interview) in a key local, county, or state newspaper, or other media outlet? The support of the broader community will be essential to achieve mental health and substance use goals in reform. That support won’t happen unless we get the word out, achieve meaningful partnerships, and foster strong community support.
Act: Nothing substitutes for clear personal action and leadership. Whether the action is a newspaper interview, participation in a community discussion, testimony in a legislative hearing, or direct contact with your Senators or House Member, your personal action is essential.
Let’s go for it!