All in Favor of Health Reform, Please Signify…

BHC Features All in Favor of Health Reform, Please Signify…

All in Favor of Health Reform, Please Signify…
(Scroll to the end of the article to download PDFs of the Whole Health Campaign’s policy briefs on healthcare reform.)

By Ron Manderscheid, PhD
Global Health and Civil Services Sector
SRA International, Inc.

Although we are in a period of severe economic distress, perhaps unparalleled since the Great Depression of the 1930s, a majority of people still seem to be optimistic that the future holds good promise. In part, this continued optimism stems from the aggressive package of legislative reforms being put forward by President Obama. These reforms range from significant new controls on financial exchanges, to new environmental protections, to national health reform. Of the three, only national health reform has stirred significant controversy. I am optimistic that this controversy will fade like the summer heat, that national health reform will move forward, and that mental health and substance use care and prevention will be part of the reform.

Here, I would like to give an update on where national health reform stands today, describe the major features being proposed, and provide a brief analysis from the perspective of the mental health and substance use fields.

Currently, three Congressional Bills are focused on national health reform, two in the Senate and one in the House. These are the Baucus-Grassley Senate Finance Committee Bill; the Kennedy-Enzi Senate Health, Education, Labor and Pension Committee Bill (called HELP), and the House Tri-Committee Bill, crafted jointly by the Health Subcommittee of the House Ways and Means Committee, the House Energy and Commerce Committee, and the House Education and Labor Committee. Generally, these three Bills share much in common. Hence, I will present an overview of major common features, as well as a short discussion about some of the issues surrounding each of these features.

Universal Coverage. A foundational feature in each of the Bills is a plan to achieve universal health insurance coverage. Currently, about 46-47 million Americans are without health insurance, including about 8 million children. Several strategies have been proposed to overcome this problem: Extend Medicaid to 150% of poverty across all States and create a public option or private collaborative to offer a cafeteria of health insurance plans. Strenuous debate is currently underway about the public option and whether insurance coverage should be mandatory. In the mental health and substance use fields, we need to look beyond the debate and support universal coverage. Fully one-third of persons with mental or substance use conditions currently do no have health insurance.

Medical Home. A Medical Home is being proposed as a vehicle to decrease care fragmentation and increase the availability of coordinated, integrated care. Although some elements are already present, the Medical Home will require further definition to assure that it includes mental and substance use care, as well as disease prevention and health promotion interventions for these populations. Also, the Medical Home needs to be conceptualized to permit both primary care and specialty care to serve as the “home”. Under either model, close coordination will be necessary with the complementary service. Details about the Medical Home are sketchy in the three Bills.

The Medical Home currently is under discussion as part of a Carter Center mental health-primary care integration initiative. Much agreement already exists regarding the future framework and functions of the Medical Home. In our fields, we need to support full national implementation of the Medical Home. Mental health and substance use care consumers currently are dying prematurely for lack of good primary care/prevention/promotion that a Medical Home can offer. We also need to advocate for a consumer centered and directed Medical Home.

Quality Improvement. The three Bills propose a range of approaches to foster care quality improvement. Generally, they center on identifying and implementing documented Evidence Based Practices and mainstreaming their use. One example is Screening, Brief Intervention and Referral for Treatment (SBIRT). Specific details about measuring effectiveness of care are likely to be developed after passage of reform legislation. We need to support inclusion of quality improvement requirements in the legislation. Our consumers need to be assured that they are receiving effective care at a reasonable cost.

I am very passionate about national health reform. To me, the current effort is a once in a generation opportunity for achieving much needed system reform. I hope that you share this same passion and that you will support fully the Congressional proposals. To do anything less would not be true to our original passion for entering the mental health and substance use fields in the first place.


To download the Whole Health Campaign’s policy briefs on health reform, click on the file names below (PDF):

Press Release
Access: A Crucial Aspect of Health Reform for People with Mental and Substance Use Conditions
Financing Health Care Reform
Integrated Health Care
Leadership Policy
Payment Reform
Promoting Wellness through Public Health
Ensuring Universal Coverage
Workforce Development

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I am pretty passionate about health care reform myself. As a working disabled mom, I understand how important it is to have a health care safety net for the public. I have only private insurance and it is considered a premium plan that I pay additional money for. I still spend an additional 5k – 6k out of pocket for medicine, orthotics and other support devices. Two of my sisters have breast cancer and they have deal with insurance denials of care all of the time. I hope you are right that a bill passes this year.

Amanda Blount

HI Mr. Manderscheid,

I have been wanting to ask this question of someone who really knows what they are talking about.

Here is the issue – I hurt my back over a 1 and 1/2 years ago. I was sent to many different Drs and Physical Therapy, and on and on. MRIs, C-Scans, the whole works. I have insurance, but of course I have my co-pay. Now, here is what made me very upset. Because I now have long term pain, I have recently been approved for MYOBLOC in my back. What a change from night to day! After only one treatment, I have full function of my neck and back.

Now this is what I see as a problem.

I was in a huge amount of pain for over 1 ½ year. The MYOBLOC was available when I was originally hurt. I totally understand that Drs want to wait a few months to make sure I will not heal on my own. BUT, the total waste of dollars to my insurance company (over $200, 000) and my own co-pay is crazy. I know I am not an odd case, because I have seen this happen with many people I know. They go through years of therapy, before the Drs will even go near the really needed answer. The wasted amount of time from work, and the wasted money for everyone is unbelievable. Of course, the Drs are worried about being sued, so they order tons of tests to make sure they have covered their own case.

Also, the insurance company purchased me a TENS unit for my back. I was just curious how much this unit was on the open market. Had I paid for it myself, I would have paid for the exact same one for less than $150. Insurance will pay over $500 for the little machine. How is that? Why can’t patients get a reward by buying what they need from open market, instead from the approved dealers? The insurance companies would actually save money in some instances.

I purchased my dad a Rollator for $120. The same one on insurance was close to $300. But, here is the problem, most elderly people do not have the additional $120 to buy their own, so of course they let the insurance pay $300 for something they really need.

BTW – Why does every Dr need to take test even though the test you just had are only a few days old?. It seems like the Drs do not trust the tests they receive from other Drs. This practice wastes tons of money, and time, for everyone.

I think if everyone would take the time to look at what their insurance companies are being charged, compared to open market, they will see why our health costs are so high.

We don’t really need a national health care plan, we need realistic payment care plan. We need a way to keep the cost down. I can tell you how. Stop letting the insurance companies getting ripped off on some of the simple little things…like tons of tests, and outrageous prices on items that should not cost as much.

I don’t expect an answer as a medical profession, but I am really interested in how the new health care plan will help me and my family?

Explain how the new health care plan will stop this very obvious waste of money, without taking away the needed items for patients like FPrioleau? How will people actually get what they need when they need it, instead of being sent all over the state to get tests, more tests, and more tests, only to finally be given the “secret” cure many dollars later?

I think if less money was wasted on some of the items I have mentioned, then there would be enough money for the medical procedures which are really needed.

Amanda Blount

HI Charlie, Your idea of non-profit makes since. Why not? There are a number of non-profit companies who have big salaries for their employees. Just because you are non-profit, does not mean you have to be a charity. It just means you don’t have to make triple digit profits to show to shareholders who are worried about the bottom line.

I agree about the testing and retesting. Mine was just one example. I have a really bad muscle in my back. How many x-rays does a Dr need to determine I have a bad muscle in my back? I started to get the feeling that I had good insurance, so they wanted to keep running test. And when I said no to one more x-ray, I had to sign a form saying I denied proper care. Well of course, I went to get the x-ray (3 days after I just had one). But, again, I am just one example.

One other change I would love to see; I want everyone to receive a statement in the mail that shows the charges they have covering their medical care. I have spoke to many people who say their medical care is free. IT IS NOT FREE. It is covered by a plan of some sort, and the tax payers are paying for it. I think, no matter which insurance you have; private or public, you should receive a statement of charges.

One of the sad things I have seen; I used to work with the elderly and helped them fill out their insurance paperwork. One lady I went to go see reached for her medication, and I expalined to her she was taking the wrong one. It was the cats medication. She said it was all the same and she could afford the prescription for her cat, but not for herself. WHAT?? I told her not to do that while I was there, and I told her daughter what I had seen. Her daughter told me she would take care of it, but that was the only way they could get what her Mom needed while she was in the doughnut hole. WHAT?? I had never heard of people taking their pet’s medication! I gave her some numbers to call to see if she could get her Mom free medication. I don’t know if she ever called.

The doughnut hole needs to be fixed. I am in my 40’s. I have taken the time to try to read all the information about the doughnut hole, and I don’t totally understand how it works. How do we expect an entire generation of people who did not use a computer, who are now sick (some in and out of the hospital), and some that can’t read or write, to understand the Doughnut hole. That situation is another huge mess.