Gore's bold step on mental health
By Thomas Oliphant, Globe Columnist, 6/6/2000
CHEVY CHASE, Md. George W. Bush has come up with a new one,
requiring the establishment of a new category of campaign babbling that might
be called the politics of condescension.
Not daring to attack an important initiative by Al Gore on an issue that hits 10
million American families every year - mental illness - the Texas governor let
it be known that he ''appreciates'' the vice president's move. To give a nice
twist to his condescension, he made clear that he ''appreciates'' Tipper Gore's
involvement as well.
His campaign pointed out that the proposal the Gores made resembles 31 state
laws in the crusade to give serious mental illness ''parity'' in insurance
coverage with other diseases and that one of those laws, in Texas, was
''signed'' by Bush - another astonishing attempt by Bush to claim credit for
legislation originated and fought for by others.
Behind this junk, however, lies the fact that Governor Bush does not support
what the vice president advocates. Bush isn't aboard this bipartisan
bandwagon for two reasons - business and ideology. Big Insurance and its Big
Employer allies have the false belief that discrimination against the mentally ill
saves them money, and Bush's conservative ideology opposes expansion of
insurance coverage via any mechanism other than tax credits that block that
expansion for all save the already comfortable.
The result leaves Gore with an opening for what might be called the politics of
advocacy. Because of Bush's commitment to cutting the top income tax rates
and the huge revenue implications, his campaign is silent on scores of domestic
issues which moderate Republicans typically support. Mental health is a
classic case in point.
As Tipper Gore notes, about one in five Americans experiences the symptoms
of one of the major mental illnesses each year, but more than two-thirds of
them get no treatment. More specifically, 8 million people each year (3 million
of them children) suffer acute manifestations of these illnesses, and insurance
industry discrimination is at the root of nontreatment. Like all discrimination it
is pound foolish, given the enormous costs that untreated illness generate on
public budgets and the private economy.
''If we talk about a child with diabetes,'' Mrs. Gore says, ''We have to talk
about a child with bipolar illness or schizophrenia.'' As a former clinical
depression patient, she has provided an excellent illustration for, as she puts it,
''turning private experience into public action.'' She is not unique. The
president of the National Alliance for the Mentally Ill, Jackie Shannon, is a San
Angelo, Texas, activist whose son was diagnosed with schizophrenia 15 years
ago; and the leading Senate sponsors of full parity (with 28 supporters to date),
Senators Pete Domenici of New Mexico and Paul Wellstone of Minnesota,
come to their activism via family experiences.
The Gores propose focusing on discrimination against children that would take
two forms. One would make the kids brought into the insurance system via the
federal-state partnership to expand coverage to working poor and
modest-income families eligible for mental health coverage no different from
so-called physical health. An additional $2.5 billion over the next 10 years
would pay for this as well as more support for community mental health
clinics. Gore also advocates a $3,000 annual tax credit against the costs of
long-term care.
But the biggest change would ban insurance discrimination against all children.
The Gores' initiative spells out what it means: The proposal focuses on the
most severe and disabling illnesses that have discernible impacts on the brain
and are as responsive to treatment as many other diseases. That means
bipolar disorder, major depressions, obsessive-compulsive conditions,
schizophrenia, and attention deficit and hyperactivity disorders.
The Gore proposal would outlaw any insurance restriction on children's care -
such as number of doctor visits or days in a treatment facility, or copayment
and deductible requirements for care or drugs - that isn't applicable across the
board. The push against discrimination is at least a decade old, and is inspired
by the battle waged in the 1960s to outlaw insidious cancer exclusions in
insurance policies.
It began in the states, with parity for government employees, and the pioneer
in 1991 was Texas under Governor Ann Richards. There are now 31 state
laws requiring full parity, this year's new ones coming in Kentucky, New
Mexico, and Massachusetts. Nationally, Domenici and Wellstone won a law
banning annual spending and so-called ''lifetime'' caps in policies covering
mental illness. And President Clinton this year ordered that the federal
workers' insurance program observe parity, affecting 9.5 million workers and
retirees.
Gore is now pledged to take the next big step. It's nice to know Bush
appreciates that.
Thomas Oliphant is a Globe columnist.
This story ran on page A15 of the Boston Globe on 6/6/2000.
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