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Obama’s and McCain’s Positions on Mental Health Care

by Mike on August 6, 2008 · 52 comments

This is not a political blog. But you probably know that!

However, the 2008 Presidential election is probably the most important election we have had in decades. The candidates, Barack Obama and John McCain, have very different views of how they will lead the country and the direction they will take it.

Nowhere is this difference more pronounced than in the candidates’ views on health care and in particular, mental health care. Whatever candidate wins in November, we will see radical changes in the way health care is paid for in America and who is covered.

This post lays out each candidate’s mental health care plan along with their general health care plan. It is not done in a partisan manner, so that you can be free to choose which plan you consider the best.

Barack Obama’s Health Care Plan

Obama’s health care plan is spelled out in great detail on his web site. In essence, his positions are:

Stated goal

  • Affordable and high-quality universal coverage through a mix of private and expanded public insurance

Overall approach

  • Require all children to have health insurance. 
  • Require all employers to offer health benefits of contribute to the cost of the new public program. 
  • Create a new public plan, and expand Medicaid and State Children’s Health Insurance Program (SCHIP).
  • Create the National Health Insurance Exchange through which small businesses and individuals without access to other public programs or employer-based coverage could enroll in the new public plan or in approved private plans.

Requirement to obtain or offer coverage

  • Require all children to have health insurance.
  • Require employers to offer “meaningful” coverage or contribute a percentage of payroll toward the costs of the public plan. Small businesses will be exempt from this requirement.

A detailed analysis of Obama’s health care plan is provided on the Kaiser Family Foundation’s web site.  

John McCain’s Health Care Plan

McCain’s health care plan is also spelled out in detail on his campaign web site. Its essential points are:

Stated Goals

  • Provide access to affordable health care for all by paying only for quality health care.
  • Have insurance choices that are diverse and responsive to individual needs.
  • Encourage personal responsibility.

Overall Approach

  • Remove the favorable tax treatment of employer-sponsored insurance.
  • Provide a tax credit to all individuals and families to increase incentives for insurance coverage.
  • Promote insurance competition.
  • Contain costs through payment changes to providers, tort reform, and other measures.

Requirement to obtain or offer coverage

  • No provision.
  • Opposes mandates for coverage.

A detailed analysis of McCain’s health care plan is provided on the Kaiser Family Foundation’s web site. 

Barack Obama’s Position on mental health issues as stated in his health care plan

Obama specifically includes mental health care in his health care plan. It states:

Improve Mental Health Care. Mental illness affects approximately one in five American families. The National Alliance on Mental Illness estimates that untreated mental illnesses cost the U.S. more than $100 billion per year. As president, Obama will support mental health parity so that coverage for serious mental illnesses are provided on the same terms and conditions as other illnesses and diseases.

John McCain’s Position on mental health issues as stated in his health care plan

McCain’s health care plan does not mention mental health.

Barack Obama’s response to an email asking about mental health

In a reply to an email sent to Obama asking about his mental health care plan and his position on mental health care issues, he wrote:

Dear Friend,

Thank you for contacting me about mental health and the treatment of mental illness. As you may know, mental illness affects approximately one in five American families, and we must do more address this issue. The National Alliance on Mental Illness estimates that untreated mental illnesses cost the U.S. more than $100 billion per year. As a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, I worked to improve mental health services for people with serious problems who are going untreated and undiagnosed.

It is important to end discrimination against those with mental illness, and that’s why I support the bipartisan Paul Wellstone (D-MN) Mental Health and Addiction Equity Act of 2007, an updated version of legislation that Senator Wellstone championed for over a decade in Congress. This bill works to end discrimination against people suffering from mental illness and addiction.

I also support mental health parity. When suicide is responsible for more deaths in America than AIDS and homicides combined, we must act. That’s why I have championed efforts to improve awareness of mental illnesses and provide timely and appropriate treatment, and why I cosponsored the Mental Health Parity Act of 2007. Parity means that we don’t allow group health plans to impose treatment or financial limitations on mental health benefits that are different from those applied to medical or surgical services. The bill closes the loopholes that allow discrimination in coverage that does not apply to other illnesses.

I’m proud of my record on this issue. I helped pass mental a health [sic] parity bill as an Illinois state senator that requires coverage for serious mental illnesses to be provided on the same terms and conditions as are applicable to other illnesses and diseases.

Thank you again for contacting me on this important issue.

Sincerely,

Barack Obama

John McCain’s response to an email asking about mental health

McCain did not reply to an email asking about his mental health care plan and his position on mental health care issues.

Obama’s and McCain’s response to The National Alliance on Mental Illness questionnaire

The National Alliance on Mental Illness sent a questionnaire to the 2008 Presidential Candidates asking if they would support 24 issues under the headings:

  • Increase America’s Coverage and Improve Treatment for Mental Healthcare
  • Provide Opportunities for Homes and Jobs for Americans Living with Mental Illness
  • End the Inappropriate Jailing of Americans with Mental Illness

Obama answered all the questions with a “strongly support” answer. 

McCain, rather than answer the questions, sent the following statement:

The next President will face a great challenge due to the rising cost of health care of all types. America has the finest doctors and medical science, and the treatment of mental health has shared in these advances.  However, as with other aspects of our health care system, spending on mental and behavioral health treatments is rising rapidly.  The challenge is to ensure high quality care, establish incentives to control the growth of costs, and thereby permit greater affordable choices.   

Mental health is a necessary complement to physical health in all aspects of our daily lives. Fortunately, the path to greater quality and lower costs is to recognize this fact and where possible provide incentives to treat physical and behavioral health together.  Chronic disease is a dominant component of the growth in spending on health care and many of our citizens with chronic illnesses have a behavioral health problem as well.  For example, untreated depression raises dramatically the cost of treating the physical ailments of a diabetic.  A sensible goal is to design reimbursement for taking care of the whole patient, whatever ails them, and recognize the essential role mental health treatment plays in the overall health of the patient and the reduction in physical health needs. 

I have stressed the central role of personal responsibility in leading to lower health care costs. Personal fitness and better lifestyles, especially reduction in addictions of all types – food, narcotics, or cigarettes – can yield dramatic improvements in the cost of chronic illness and high‐cost medical care. We can do a better job of treating addictions, but we also have an obligation to do a better job of teaching our children the benefits of good lifestyles and the perils of addictive activities. 

I have a strong record fighting for the needs of America’s most vulnerable including those seeking better mental health.  I have consistently supported public housing programs that play a significant role in helping meet the housing needs of many seriously mentally ill Americans, and have been a leader in the effort to eradicate homelessness among our Nation’s veterans – many of whom are fighting mental illness.  I believe America needs strong leadership and a commitment to bold solutions to address the challenges that it faces.  We can provide quality mental health that is more responsive to our needs and is delivered to more people at lower cost.   

Obama and McCain on H.R. 1424/S558 “Paul Wellstone Mental Health and Addiction Equity Act of 2007″ bill

One of the great injustices of the current mental health care system is its lack of parity among payments for medical, surgical and mental health care services. If mental health care services are offered by an insurance plan at all, they often come with lower payments and more restricted coverage than for medical issues, as well as a lifetime cap on payments for services.

Obama co-sponsored, along with 56 others, the bipartisan Senate’s S558 version of H.R. 1424 “Paul Wellstone Mental Health and Addiction Equity Act of 2007″ bill. McCain did not co-sponsor the bill. The White House is opposed to it. 

The bill passed the House of Representatives on March 5, 2008 and has been placed on the Senate Legislative Calendar under General Orders. This legislation would require health insurers to offer mental health benefits equal to the coverage offered for medical and surgical benefits. 

Summary

Whatever else you think of Obama’s health care plan, it does address mental health issues directly. It seeks to end discrimination against people with mental illnesses. It specifically states that he will work toward parity of coverage among mental health, medical and surgical services in the health care system. Obama’s plan does not change the current relationship between primary care doctors and mental health professionals.

McCain does not mention mental health care in his health care plan, and his approach to it is not clear. His response to the National Alliance on Mental Illness questionnaire seems to combine mental and physical health together in a more holistic approach. He states that he would, “where possible provide incentives to treat physical and behavioral health together.” This implies that he would favor the first line care of mental health issues to be handled by family physicians or primary care doctors rather than by mental health professionals.

What do you think?

  • Do you favor Obama’s or McCain’s approach to mental health care funding?
  • Do you like McCain’s more holistic treatment of health care, or Obama’s staying with the current relationship between primary care doctors and mental health specialists?

As always, your comments are welcome!

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Resources used in this post:

2008 Presidential Primaries: Bringing Mental Healthcare to the Ballot – National Alliance on Mental Illness questionnaire results  

Barack Obama 2008 Presidential Campaign Site  

Barack Obama’s Health Care Plan: “Plan for a Healthy America”  

Barack Obama’s Response to the National Alliance on Mental Illness questionnaire (PDF) 

John McCain 2008 Presidential Campaign Site  

John McCain’s Health Care Plan: “Straight Talk on Health System Reform”  

John McCain’s Statement in Response to the National Alliance on Mental Illness questionnaire (PDF)

Kaiser Family Foundation – 2008 Presidential Candidate Health Care Proposals: Side by Side Summary  

Kaiser Family Foundation – Health08.org  

National Alliance on Mental Illness questionnaire 

Sparks, Alicia – “What Do You Think of Barack Obama’s Stance on Mental Health Parity?” 

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