Late-summer phantoms are just mirages

BEHAVIORAL HEALTHCARE

Issue Date: September 2009,
Online Exclusive

Late-summer phantoms are just mirages
Let’s put to rest the fears stoked by our nation’s very hot health reform debate
by Ron Manderscheid, PhD, Editorial Board Member

One need only see a few moments of the sharply differing partisan reactions to President Obama’s healthcare address to Congress to see that the national healthcare reform debate is generating more heat than any late-summer Washington, DC day ever could. Accusations and counter accusations, claims and counter claims, misrepresentations, intended or otherwise, continue to fill the evening news, overflow into the streets, and spin the perceptions of the uninitiated. Thus, it’s a good time to debunk the phantoms of healthcare reform. Some, such as the assertion that health reform is a Nazi plot, are so outlandish as to not deserve any response at all, but several others have acquired a significant, if misguided, following.

The “’Public’ Option.” This issue has hardly been shaped sufficiently to even be called a phantom. Each of the three Congressional Health Reform Bills is attempting to extend insurance coverage to the 46-47 million persons who are without health insurance. One way of doing this is to create a new public insurance program, like Medicare, which has been operating successfully for almost 45 years. Another is to create an insurance collaborative on the model of the Tennessee Valley Authority (TVA), much like the Federal Employees Health Benefit Program (FEHBP), that would offer a choice among insurance plans. Either of these options can be combined with a third—contracting with private insurers. Both Medicare and FEHBP already contract with private insurers, but in slightly different ways. Important to remember in this discussion is the fact that the dollars needed to pay for any of the options primarily will be public funds. As of now, no decision has been reached regarding which option to choose, even though some loud voices would assert otherwise.

“Death Squads”. This phantom has been made famous because of its originator, Sarah Palin. None of the three Bills on the Hill would set up such an arrangement. What they would do is encourage discussion between providers and consumers about future care. As of right now, this provision is not even sufficiently precise to encourage discussion of living wills or advance directives. I hope that the vast majority of you will agree that a living will is an important way to express one’s own wishes about future care (I have one), and that a strong system of advance directives is an important tool for self-determination, so important in our fields.

“Loss of ‘Choice’ ”. This is a perennial phantom that has been around since the days of Clinton Healthcare Reform. In contrast to this phantom, the Clinton Health Security Act was actually designed to expand choice, and the current effort is attempting to do so as well. Think for a moment about how many choices you would have as an uninsured person entering an emergency department for care. Health insurance coverage promotes choice—choice about type of care and choice about provider.

“Loss of Benefits.” This phantom and its cousin, “Trimming of Benefits”, arise from the fear that health reform will promote denial of needed care. In reality, becoming newly insured will actually promote the availability of needed care. For the currently insured, it will promote the availability of evidence-based care and decrease the availability of ineffective care, both of which are to be desired.

“Health Reform will Bankrupt Us.” This phantom arises from a lack of knowledge about the three Bills on the Hill. Each of the committees has worked (and reworked) their proposals to balance insurance expansion proposals against revenue proposals. Also, President Obama has stated in very clear terms that he will veto any Bill that proposes deficit spending. As he pointed out, a failure to take action to reform healthcare is much more likely to bankrupt the United States Government.

I hope that I have convinced you that much of what you are hearing about healthcare reform on the evening news or seeing in the streets is simply untrue—a phantom, a mirage created by the intense, late-summer heat around this issue.

We want to assert clearly and unequivocally that national health reform is needed urgently by the mental health and substance use fields. More than one-third of uninsured persons have mental or substance-use conditions. We also want to assert that care quality must be improved. The fact that public mental health consumers die 25 years prematurely is compelling evidence that this need is extreme. Finally, we want to assert that the national health agenda must be expanded to include prevention and promotion. We don’t want to just be alive; we want to be healthy, vital, and dynamic.

In Franklin Roosevelt’s very first speech as President, he uttered several words that inspired our Nation, “The only thing we have to fear is fear itself”. These words clearly apply today. The only thing we have to fear are the phantoms, the mirages that are created when fearful people confront a hot issue and an uncertain future. Just as the heat of the late-summer sun fades into fall, let’s let these fears fade away as well. President Roosevelt would be proud.