January 12, 2008

Clinton and Obama on Mental Health Care 2008

I have included no one else in this discussion, but I figured that the two front runners for the only party I will discuss in this forum in terms of the presidential campaign are, in fact, Hillary Clinton and Barack Obama, probably now running neck and neck. I myself find it hard to choose between the two, liking each for different reasons.

I am very much enjoying Barack Obama's memoir DREAMS FROM MY FATHER, which is very well-written, even lyrical in places, so that it is a real pleasure to sit down with it. While I learn about his background, his past, and his past dreams and hopes and struggles, what made him who he is today-- who he is today I still do not know. I must go on to read his second book and more of the campaign information at his website and so forth and see what I can find out. I suppose I should have been doing so all along, but better late than never...Today, though I will report to you on his views on Mental Health Issues.

People who campaign for Sen. Obama seem inspired by his rhetoric of hope and change, and I think that anyone who inspires the young to want to work for the country's sake instead of merely for themselves, anyone who can act on their spirits as JFK did once on us, is a great asset to the party and to the nation. In that light, I watched Obama's 2004 DNC speech that I was told so many found awe-inspiring. If it had been only a speech, alone or in another context, it would indeed have been rousing and spirit-lifting, even 4 years later. But the problem is that when I watched it, it was four years later. As I listened to that speech that purported to be stumping for John Kerry, I understood with sudden clarity that it was actually a campaign speech for Obama, who even then was positioning himself for this very moment, in 2008, when he would be the one campaigning for the presidency. If you listen to the recording, you will hear it at once. He does not speak of Kerry except in passing, only of Obama's dreams and his purposes and his aims...If he mentions Kerry it is as if it is only by accident, or because he suddenly remembers that this is actually supposed to be a speech on Kerry's behalf and not yet an Obama campaign speech! That's not to say that the crowd is not enthusiastic and roused and inspired to vote for Kerry, though I think Kerry was not much on their minds during the speech, even if they did vote for him (it was a done deal anyhow).

I dunno, I have not seen many of these DNC speeches, and maybe that's what they are meant to be, pre-campaign speeches by the up and coming, ways to position onesself for the future, and not really a speech on behalf of your candidate. Was that what Barbara Jordan's famous speech was like way back when? I don't recall, because I was not mentally able to pay attention back then...

So, while Obama speaks of change, of changing the way things work in Washington, he himself is the consummate politician, at least in the sense that he planned his campaign for the presidency from this speech four years ago and very shrewdly. There is nothing wrong with that, only that no one should think this "grass roots" thing just sprang up out of nowhere...On the other hand, to raise some $20 million plus in small donations is nothing to sneer at...

Now as to Mrs Clinton, well, I need to learn more about her too, except that of course she has been a public figure for much longer, so some of her story has percolated through into my thick skull despite its firm resistance anyway. She has in fact more experience than Mr Obama. For now. Whether that matters, since her own husband did not have much more at the start of his presidency, remains to be seen.

I cannot evaluate Clinton properly anymore than I can Obama, what I can do is put up for you a comparison of what the two candidates each said in their response to a questionnaire given to them by NAMI on mental health issues. I did not compare every single question, only picked out a few issues, juxtaposing Clinton's responses with Obama's. This is how they answered NAMI's questions, in their own words.

NAMI's Questionnaire for 2008 Presidential Candidates

1. Support mental health and substance abuse coverage in all plans to provide affordable health care?

Mental health is an essential component of every American’s overall health care status. Since mental illness is the leading cause of disability and affects 25 percent of Americans, I recognize how important it is to address this vital part of health care. As such, I am determined to do all that I can to increase understanding about mental and behavioral health and improve access to quality care and treatment for all Americans.

To improve access to health care services, including mental health care, my American Health Choices Plan will provide quality, affordable health care to all Americans, including the millions who don’t have coverage today. My plan allows people to join the same plans that are available for Members of Congress, most of which cover mental health care and many of which cover substance abuse treatment. I believe we have a moral imperative to ensure that every American has access to the quality health care they need, which is why mental health services will be included in the Health Choices Menu. Working with Congress, I will make passing universal health care my top domestic priority.

My plan also covers prevention, which will not only improve Americans’ quality of life, but also reduce lost wages and enhance workplace productivity. Under my plan, insurers participating in a federal health program, like Medicare or Medicaid, willl have to
cover prevention as a condition of doing business with the federal government. Recognizing that early detection and treatment of mental illness can result in a much shorter and less debilitating illness, we must do what we can to keep people healthy.

My American Health Choices Plan will prohibit insurance companies from discriminating against people on the basis of age, race, gender, or other risk factors, including pre-existing conditions like mental illness. Insurance companies will be required to continue to provide insurance to people who have paid their premiums and want to continue coverage. Under my plan, the days of insurance companies competing over how to exclude people from receiving the care they need will come to an end. It’s just wrong that people pay for insurance and then insurance companies work to determine how not to cover people when they are sick.

My national health plan will guarantee affordable, comprehensive and portable health coverage for every American through partnerships among employers, private health plans, the federal government, and the states. In addition, my plan will include coverage of all essential medical services, including preventive, maternity and mental health care.

3. Ensure that active duty military, veterans and reservists receive the mental health care and disability payments they need to live successfully with mental illness?

Our country has a duty to reform and ready the military for the increasing number of veterans, active duty military, and reservists suffering from mental illness. The wars in Iraq and Afghanistan have resulted in increasing numbers of service members returning with Post-traumatic Stress Disorder (PTSD) and other mental health conditions. As a member of the Senate Armed Services Committee, I am working hard to ensure our men and women in uniform and their families have the care and support they need and deserve. In October 2006, as part of the 2007 National Defense Authorization Act, the President signed into law major pieces of my Heroes at Home legislation, which requires the establishment of a working group to identify ways to help Guardsmen and Reservists transition back to civilian jobs after deployment in Iraq or Afghanistan and sets up a DOD Task Force to assess the mental health challenges – including PTSD – faced by members of the Guard and Reserve. In September 2006, I secured $3 million in initial funding for Heroes at Home in the annual Department of Defense Appropriations bill.

In March 2007, I introduced new legislation to build on Heroes at Home. Specifically, my legislation would expand the use of telehealth and telementalhealth services, which can be particularly helpful to service members or veterans living in rural areas, and help family members taking care of a loved one to get training and certification for dealing with brain injuries and psychological injuries.

In the 109th Congress, I also cosponsored the Healing the Invisible Wounds Act of 2006 with Senator Daniel Akaka and other colleagues. The legislation would protect PTSD compensation, enhance counseling and readjustment services available to National Guard and Reserve members returning from a combat theater, and authorize additional funding for Vet Centers.

A recent military survey found that 49 percent of returning National guard members report psychological symptoms, a higher figure than their active-duty counterparts. Relative to active duty troops, guardsmen, reservists and their families have limited access to military chaplains, family support programs, and other programs designed to support psychological health. I will work to improve mental health care at every stage of military service – recruitment, deployment and re-entry into civilian life – so that active duty military, veterans and reservists receive the mental health care and disability payments they need for a productive and successful life. My commitment to the mental health of our citizen-soldiers includes:

Recruitment: Recruiting more mental health professionals; improving screening; and instituting fairness by guaranteeing that if the military determines on the front end that an individual is fit to serve, that individual will not be denied benefits on the back end on the grounds of a “preexisting” condition.

Active Duty, Training, and Deployment: Placing more mental health professionals with troops as they train, deploy, and return; fighting the stigma of psychological injury by enhancing training; and helping military families by offering more counseling and support to family members.

Return to Civilian Life: Requiring individual, face-to-face post-deployment mental health screenings; increasing the VA budget to recruit and retain more mental health professionals; making PTSD benefits claims fairer and more accurate by providing better training and guidance to personnel; and expanding Vet Centers in rural areas so that veterans and their families can get the care they need where they live.

Support for Guardsmen: Placing a mental health coordinator in each of the states’ Adjutants General’s office and giving the states the resources to provide better follow-up following a guard unit’s return from deployment.

I was also an original cosponsor of legislation to improve care for traumatic brain injuries (TBI). As president, I will establish standards of care for TBI treatment, require pre- and post-deployment screenings and improve case management so that servicemembers get the best possible care.

7. Support Medicaid coverage and reimbursement of effective, recovery-oriented and evidence-based mental health services

Medicaid is a vital source of health care coverage for millions of children and families and acts as our nation’s health care safety net, providing coverage to more than 50 million individuals nationwide, about half of whom are children. As the largest payer of mental health services, Medicaid is an important component of our nation’s mental health care system. As such, I am deeply concerned about the Medicaid cuts that have been proposed by President Bush, including limitations on the availability of Medicaid rehabilitation services. That is why I supported a moratorium on this proposal in the recent SCHIP reauthorization legislation. Arbitrary Medicaid cuts that limit access to quality care for millions of low-income Americans are unwarranted and would only worsen patients’ health statues. As President, I will work to ensure that the Medicaid system remains a reliable source of health care coverage for our low-income working families and children

I believe that Medicare policies should provide effective mental health services for people who live with mental illness.

11. Support policies that eliminate the inappropriate use of seclusion and restraint and foster humane alternatives?

There is no room in our society for the inhumane treatment of patients. As such, I believe that the only case in which it is permissible to subject mental health patients to restraints or involuntary seclusion is if their safety or the safety of others is at risk. When appropriately used for emergency safety purposes, these practices should be ordered and supervised by a licensed professional.

The focus by the medical community on improving health care quality has increased dramatically, with specific attention to underuse, overuse and misuse of health care interventions. The use of seclusion and restraints has been identified as a serious area of concern and I will expand and accelerate research to determine appropriate use, if any, and the development of effective and humane alternatives.

12. Support accelerated investment in National Institute of Mental Health research on mental illness, co-occurring disorders, recovery and reintegration into the community?

We live in a time of extraordinary and historic opportunity in medical research. For example, research on the mind, brain, and behavior leads directly to clinical advances in mental heath treatment. As such, we need to lend support to the National Institute of Mental Health (NIMH) and other institutions so they can forge a path to revolutionary treatments, disease management and eventual cures. As an advocate for health care progress, I have long been a strong supporter of efforts to increase the budget of the National Institutes of Health (NIH), including NIMH. As President, I will push to double the budget of the NIH, including the NIMH.

I fully support greater investment in NIMH.

20. Support programs and policies that result in competitive employment for people living with serious mental illness?

I strongly believe that we have an obligation to help those with disabilities – including chronic mental illness – achieve meaningful employment opportunities. As a testament to this commitment, I rigorously fought the Bush Administration’s “WIA-Plus” proposal, which would have undermined the Vocational Rehabilitation program by allowing states to spend the money on a wide range of activities, including those that would not help individuals with disabilities address barriers to employment. As President, I pledge to financially support the Vocational Rehabilitation program. In addition, my husband was proud to sign into law the Work Incentives Improvement Act, which created the Ticket to Work legislation. This bill made it possible for individuals with disabilities to maintain their Medicaid coverage while working full-time. I believe people shouldn’t lose their health insurance if they choose to go back to work, and that we should work aggressively to remove barriers to work for individuals with disabilities.

On the eve of the 17th Anniversary of the Americans with Disabilities Act, I announced a four-point agenda to improve employment opportunities for people with disabilities, which can be accessed here: In it, I said I would promote innovative employment strategies for people with disabilities, double funding for assistive technology loan programs, provide more technical assistance for employers, and expand innovative state and local job connection strategies. I also said I would re-establish the Clinton Administration’s goal of hiring 100,000 individuals with disabilities, enact a $1,000 refundable tax credit for workers with disabilities, and reduce disincentives to work in federal programs like Medicare and SCHIP.

I believe that qualified workers with disabilities or mental illness should have the same opportunities as other workers. My goal is to increase the employment rate among workers with disabilities or mental illness so that it is as close as possible to the employment rate for all American workers. I am committed to funding and better enforcing the Americans with Disabilities Act, as well as strengthening other legislation to ensure that individuals with disabilities or mental illness have equal opportunity to participate in the workplace.

I also believe that the federal government should be a model employer of workers with disabilities or mental illness. I will direct all of my department and agency heads to bring their agencies into full compliance with all aspects of the Rehabilitation Act. To assure that the federal government holds itself to high anti-discrimination standards, I will increase funding to the Equal Employment Opportunity Commission and assure that the person I appoint to chair the Equal Employment Opportunity Commission is committed to enforcing anti-discrimination laws that protect federal employees through a strong Office of Federal Operations. Perhaps most important, I will provide leadership to my appointees throughout the executive branch so that they, employers in the private sector, and workers with disabilities across the country will understand the importance of this issue.

Further, I believe that employment opportunities for people with mental illness can be increased through better educational opportunities. I strongly support full funding of the Individuals with Disabilities Education Act (IDEA) and passing legislation that will fund school-based mental health services

21. Support maintaining health care coverage for people with disabilities who return to work?

I firmly believe that programs like Social Security Income (SSI) and Social Security Disability Insurance (SSDI) provide an invaluable safety net for those individuals that might need governmental assistance. I am committed to helping beneficiaries of SSI and SSDI not just make ends meet, but also improve their life and meaningfully participate in society. As President, I will examine these programs to see how they should be improved in order to ensure that Americans living with disabilities are able to participate in the labor market to the degree they are able. I will ask top government officials to work with health, retirement, and disability experts to review and make recommendations on how work disincentives can be eliminated from major federal programs such as SSDI, SSI, Medicare, and Medicaid eligibility. This review will develop recommendations to eliminate inconsistencies across states and will require HHS to release a best practice report that will make explicit recommendations to reduce disincentives to work. I will also eliminate the Medicare time-limit, allowing individuals to continue to work as long as they are able, and still retain Medicare eligibility. In the Senate, I cosponsored the Ending the Medicare Disability Waiting Period Act of 2007, a bill that sought to phase out the waiting period for disabled individuals to become eligible for Medicare benefits.

My health care plan will provide quality health care coverage to all Americans, including people with disabilities who return to work. My plan will guarantee affordable, comprehensive and portable health coverage through partnerships among employers, private health plans, the federal government, and the states. My plan also recognizes that although all Americans are affected by problems with our health care delivery system, certain patient populations are significantly more likely to experience difficulties gaining access to health care and to receive lower quality health care. I will require that all health care providers collect, analyze and report data on the quality of health care given to vulnerable populations, including those with disabilities, to ensure appropriate care and good health outcomes. My plan also emphasizes care coordination and integration, which is particularly important for individuals with disabilities who often have multiple providers. Last but not least, I will support additional training of health care workers so that they are better able to address the needs of disabled populations.

22. Support increasing programs to divert people with mental illness from jail into appropriate community treatment?

SAMHSA currently funds pre- and post-booking jail diversion pilot programs at the local level. A 2004 evaluation of these programs by SAMHSA found that jail diversion participants spent less time in institutions and more time in the community. The evaluation also found that while the initial costs of these programs was more expensive, they resulted in overall savings to the criminal justice system. I believe that these results are promising, and we should be looking at ways to expand best practices from these pilot programs so that we can better treat non-violent offenders.

I support a smart and effective crime policy that ensures that individuals with mental illnesses receive the treatment they need.

Posted by pamwagg at January 12, 2008 01:22 PM | TrackBack


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