energy, in particular the next few months. you'll get a feel of that during the debate today. this is not just an educational or process for me, this is a very personal journey. en when i was in buffalo my uncle --..

>> and so i developed a hospital and then i went into the insurance and developed services for the needy. i've always had a particular interest in serving the underserved. yes, we had a challenge in that health care reform was not past several years ago, but we can't let that bother us. we must move forward. this is the time right now, that this is a most unusual time where we have the president, the congress and the public will to pass this. and we hope that this panel

today will enlighten that debate and help move the process forward. my first question is to chris jennings, tell us, chris, what you think the likelihood of passage will be. and i want to talk about the government-sponsored care, program and the newly discussed cooperative. >> sure. it's certainly a pleasure to be here again before you all. i think all of us in one way or another have been touched by mental illness, and i'm certainly no exception. i want to thank tipper gore for leading us all. i mister. she has quite a warm-up act to follow. i think we should reverse that in the future. but let me get straight to your question, ron. i'm absolutely under actually more optimistic than i have ever been on the health care reform.

having said that, i always say that health care is always more unlikely than likely, but it's more likely than it ever has been. and i look at all the differing reasons as to why, but i think it's important that you know these reasons and then i'm going to talk specifically about which feeds into why i'm optimistic. one, i think that you are seeing the policy discussion is much more open, it's much more integrated. none of the policies that people can unfairly, fairly mischaracterized is in these packages that members of congress are contemplating. so the sort of fear issue is hard to play on. as you know, all too often in the health care reform debate fear be told. in this contest i believe that the policy is actually served as a barrier against critiques. i'm not saying that there will be the usual hostile assaults, there will be.

but they will just not be as effective. secondly on the messaging, you have seen the president has been very, very active and involved, but leading off and building on something that senator clinton always that which is if you like it, keep it. if you don't, we will have new options for your. with that phraseology in and of itself it's a very comforting message. people say okay, they're not going to mess up my stuff except they might make it more affordable but we are providing another choice. up another important element. the third frankly is the process, and this is why i am more encouraged and that gets integrated into the personnel. the process is not going to be president obama's plan or senator baucus is planned or senator kennedy's plan or chairman waxman's plan. is going to be our plan. is going to be our plan because this is being -- this is a process that's been worked out on capitol hill with members on both sides of the aisle being very, very invested in what the

policy is. a very important difference in what we tried in the last time around where we had a proposal that people just shot at. now the members of congress got a general vision of what the president is looking for, provide significant resources to get them there, and then he provides what i would suggest air cover to keep pushing the public to push the congress to act, and in the congress does what it does which is it legislates. and the last thing i'm going to just mention as to why i'm more optimistic than ever, and we can talk about the special challenges and the opportunities for the mental health community, but i'm going to let you ask a question about that. but really isn't this issue of the stakeholders. sometimes in washington or outside washington called the special interest. in this context, the stakeholders are as invested, if not more invested, and seeing

something done. and there is a reason for that. they are saying that the current market share is declining, whether it's on the health plan, the pharmaceutical industry and the brand. they are saying people can no longer afford their products and they are not able to access it. but just as important is their analysis of what we call washington the baseline. what's going to happen in the future if we don't act. no longer is failure the second best option, because they know that in two years if you look at the budget, if you look at the deficit we're going to have a substantial conversation about debt and deficit. and if we don't take advantage of this opportunity, to pass health care legislation and use the reforms that everyone knows we need to do to constrain costs, we invested in health care system and not back to the tax cuts but back into the health care system that's a far better deal for them.

and their interest than waiting two years down the road and having a deficit on discussion and just talk about cost cuts and cost that we always had an 80s and 90s. so for all those reasons i am very, very optimistic recognizing what i lead with which his it's always more unlikely than likely. >> joanne, could you comment, the key element to this plan is most of us agree the biggest controversy is the issue of what is called the government option, the issue of having a government-sponsored plan which would compete with the four and not for profit health care plans. can you give us your thoughts on that? >> will, to answer that i think i need to back up a little bit. we come to the debate with a goal of bringing down costs and making coverage more affordable and available to more people. you might ask why unions see the need for health reform. most of our members have good benefits that we have seen year

after year contract negotiations, this is the most difficult issue to solve. we've tried, you know, we've had more than 10 years out partnering with health plans and other purchasers to improve quality and get better value for our spending. we have tried pilot programs, purchasing cooperatives with unions, but we can't solve it at the bargaining table, we can't solve it on her own. a national solution is what we need. and our folks get that in order to lower their costs, we need to get everyone in the system. we need to, you know, they understand that their premiums are reflected on and on coppery care, they know they spend more money than they need to not get the value for. so we come to the health care for rebate wanting to see everyone covered and lower costs, access to good benefits made affordable to everyone. and two of us a key piece of that is not the only piece, is the public health insurance option for everyone alongside private insurance option and to inject competition into an imperfect market to lower cost, to be a standard that consumers

can go to. and so it's not for us to just something in name only, it's not just a convenient principle or philosophical divide. is a key piece and i think some of the negotiations you hear were grateful, we're happy i guess to say that the senate there needs to be a public plan, it's more debate now about how to define or structured. >> tom, representing the american health plan insurance health plan, organizations, i think you have a strong opinion about this. >> well, yes. i first want to stay by thinking mental health america for the invitation to join you today. obviously i'm not caring, and i want to share her regrets, she got called to a meeting on the hill and is dealing with that. and the second thing i want to say is harry and louise argonne. you're not going to see them this time around. [applause] >> for the past couple of years we have been working with our

board on a real intensive effort to look at health care reform and to look at what's really needed to get folks access to affordable coverage. and that's been our goal. and i just want you know follow on a couple things that chris said before i talk about this issue of a government plan. for the last couple of years i've been working on mental health parity and i think that actually was a very good model for this whole effort to get health care reform through congress, and i'm starting to see that duplicated. there's really three kind of components to mental health parity. there was a very strong push from the communities and from the grassroots telling the politicians and quite friendly telling us something needs to be done. we are starting to see that, you know, duplicated. second of all there's champions with mental health parity. you obviously had all wellstone

and senator kennedy, patrick kennedy, and others, you know, who were willing to take ownership of the issue and see that it got pushed through. obviously you are saying that now with the president and congress having a very strong commitment. and finally, you're saying as chris said the stakeholders or the special interest, whatever you want to call it, and i don't use that term, its patient advocacy groups, its providers, its employers who quite frankly picked up the ball to the health care costs in this country. gets other saying we want to get this done. we want to get this problem solved, and we are going to sit in a room until it happens. so i'm also very optimistic that you are going to see something accomplished. but there are some very big issues that need to be resolved. dealing with the underlying cost of health care is one of them. figuring out how you're going to pay for all this is one.

and the other three big issue obviously is of the government plan, and our concerns about a government plan are the president says and everyone says if you are happy with the health care you have now, you get to keep it. we're not going to blow up the current system that we have. in fact, most people who have insurance habit through their employer. most people who have insurance coverage are happy with it. it's not perfect. there are frustrations. there are a lot of folks you don't have coverage that we need to get access, but i think the central theme needs to be let's not destroy what we have in order to fix the overall problem. with the government plan, in essence what you are doing is over timeshifting people into that plan. a government plan because of the breadth and depth of it basically can dominate the market. if you look at, for example, the

kennedy bill that just got introduced, they are looking at, say medicare rates plus 10%. on the commercial side we typically pay between 20 and 30% over medicare. so if you're an employer, if you look at her underlying cost structure it makes more sense to go to ship everybody to the government plan. that internships a lot of cost back on the commercial side because now we know with medicare and medicaid, because of those reimbursement rates, providers shift a lot of those cost back on the commercial side. we think that a government plan despite its very nature is not as nimble and it's not as flexible in terms of recognizing the medical advances and recognizing new benefit designs. you've got basically a package that the government says this is what we are going to cover, these are the doctors you get to go to. so i think in terms of the government plan, there's just a

lot of concerns that it's going to kind of become the dominant market player. it's going to weaken what we have now that's working, and not really help those folks who need access to affordable coverage. >> if it meant getting something passed, do you think the afl-cio would go a long with not having a government plan, if it meant a first step? >> again, it's not -- it's the total package and what we are able to achieve in terms of having everyone. it will improve quality and get better quality for our spending and bring down cost to really start to affect his future trend swallows family budgets, business, you know, budgets and federal budget itself. so i think at the end we have to look at whether or not to achieve those goals and we think a public health insurance option is in the realm of the. >> i would like a few minutes on

the cooperative, and i know mike, you're an expert on cooperatives since your work in florida is with the orange growers and other cooperatives in america. i'm joking with you. to i thought you could give us at least, i think we ought to spend at least two minutes on it because it is, senator conrad maginot brought up from the dakota and i think in you give us a few minutes no. >> not particularly, i actually would rather have one of my colleagues here who is closer to that conversation, but let me set it up in the sense with a bridge to the concerns to many of the people here that i think probably you are going to take is doing just a second, ron, so what about mental health in all this. i'm really struck as a comparison with 1993 and today

the contrast between we know now that that wasn't going to happen on the one hand. on the other hand, we had a task force led by mrs. gore that was focusing 100% on mental health issues. this time around as these folks were much more knowledgeable about it than i seem to believe we think it's going to happen and i can't identify one person in our community who is involved in this central in these conversations. this is not necessarily a bad thing. in the parity that has now been established, and it is of the law of the land. but i still get a little nervous because the most recent piece of legislation that we just had passed, the recovery act, if you were to say does an economic depression like have anything to do with clinical depression i would be like to know how much specific to mental health was there in the recovery act, zero.

so i remain a little bit concerned about all this. the other reason why i don't get, you know, really scared about the absences specific is that one of the things that is probably crucial to the approach is that each of these folks has emphasized that at a first level it's about creating a broad framework, that's going to have to address certain issues of benefits broadly and a delivery system broadly. so not having details about mental health yet is not necessarily a bad thing. as i think of advocacy that we are all going to have to be involved with later down the road, i'm going to make one point. most people never see a mental health specialist for their condition. they go see, whether it's a pediatrician or family medicine person or a gp, and if we just take the case of the mental

health condition which is the most prevalent as reliably diagnosed and effectively treated 75% of the time if you do the right thing, which is depression, and general medical setting depression is identified less than half the time and at less than half the time when it's identified as it treated responsibly. so at some point, not necessarily right now because it might just muddy the waters here, but at some point we're going to have to get involved in a conversation about what about this. >> it is the point. you're leading us right into it, and we want to ask chris, you know, who in fact is leading the veteran package and how can we collectively, we, be sure that mental health is covered in a comprehensive, integrated manner for all our citizens? >> well, and i will do that and i would just put in a final

point on the public plan, a final point. and i think that i think inevitably something called a public plan option at the end of the day. the day is going to be very important to health plans and providers and manufacturers about exactly what that is and how it's structured. and i think this discussion is important and relevant, and has though really serve as an extraordinary distraction over the extraordinary other millions of the issues that are part of the health care reform debate. in some ways that's been constructed and in some ways that hasn't been and we can talk about them. but i will predict to you that there will be something, god knows what it will be. but at the end of the day it won't be the fundamental most important part of the health care reform debate. and serving out the mental

health community. let me then transition to those issues. i would suggest, first of all, that you deserve an extraordinary amount of acknowledgment and credit for your work on the mental health parity legislation because it sets you up very well for this broader discussion. in other words, now if there is a discussion, no matter what, you're automatically included, and boy, is that a relief. you don't have to worry about that. however, as we all know in this room, for people who we know and love, much of our medicaid system is our mental health care system. much of our mental health care system is the medicaid program. much of the problems that populations afflicted with mental illness have our lower income people. and this is a really important point about the health care debate. we have to talk about when we're

talking about delivery changes and reforms, and when people are discussing, you know, in washington all people will talk about is the prevention of and care for the chronically ill. who is the mentally ill? who are the people we can prevent the mental ill? that is your issue. you should own it. you should own the issue. and i suspect you will. you just need to make sure that -- by the way, you should say don't act as though mental illness is an issue that's independent of or somehow out of this broader debate. it is fully integrated and must be addressed as such. and as you do that, you will find -- so you are saying you're right, senator so-and-so. you're right congressman so-and-so. this is the biggest issue, chronic illness. and if you want to do chronic illness right, if you want to do

prevention right, you must do this. and as soon as you use that, what you are doing as a strategy is the best energy you can in washington, you are attaching your train car to the engine. okay. and that's what i think you will need to be doing on all these issues. >> very, very good advice. the kaiser foundation did do a perfect study which basically said by bringing the uninsured or as many as you can into the medicaid program, expanding the medicaid program, it would save massive amounts of money and you would get people, citizens which are already working in organized, how do you feel about that? >> i want to come back to what chris said, in that regard, and for me it may seem counterintuitive as somebody who works in the state. but a focus on what exactly the mechanism is going to be. i would say a secondary because

the most important thing is that there is a robust approach to reform that has these commonsense -- these commonsense elements. but just to reinforce the point that chris has talked about from where we sit. i mean, what a message that wellness and prevention are now understood by the american public and increasingly by elected officials as central to health care reform, is that in a sweet spot of mental health america or what? so then the question is, how does that say of it made? i know that doctor ron kessler will talk at this conference about his findings that the average person who in the course of their life will experience a mental disorder will experience it by the age of 14. 75% by the age of 23. and that the average lifetime between first having symptoms and interim chair is nine years. in the united states of america.

so the understanding, for example, of how untreated mental depression can interrupt the mom's ability to turn on those receptors in the baby's brain that are critical to developing the relationships and how that can leave later on to behavioral problems and a conduct disorder, you know, which we understand the scientific link there. the report just out from the iom about prevention, and the report just out about depression in young people and their adults, boy, is this tough time at. so the question though of how we make the sale to, and i really like the metaphor of poking our car to that train. what our message is, in this community, we're going to have to get a little bit clearer about, but i think a message about prevention and wellness and the centrality of the surgeon general said mental health is essential to overall

health. that have to be what we focus on. >> and there has been some interesting studies that show a significant of how mental health affects physical health, and that if you look at the cost of treating depression with someone who has either heart disease, diabetes, any chronic illness, heart disease, by treating that mental illness, the general costs go down and it's a pretty powerful argument. >> i think so. and i know from my mom who lived with diabetes and depression, when she wasn't taking care of the depression there was no way she was going to check her blood levels and her blood sugar levels. just no way. this thing goes to something else that maybe it's premature for the conversation right now but i'm increasingly thinking about, and that is that i think we understand now that in the general medical settings, and less there is a mental health specialist who is on the team and on the floor, it's not going to get done.

somewhere around 44% of gps say they are comfortable with detecting and treating the debt under an depression. if we look at alcoholism, that drops below 20%. so one of the things that this is going to require is we are going to have to figure out how to have a specialist, not over on the other side of the street in the mental health center, but in the pediatricians office, and a chronic disease program. [applause] >> so in this context, it clearly is true that a parody is a great place to start, but we have got to understand, when it comes to prevention and treatment, parity is insufficient. parity is illegal or asset to a benefit that most people don't use because of their condition doesn't identify it. >> we should spend some time talking about expanding your

interest in wellness and prevention, the whole recovery movement is central to what we are doing. and i know the afl-cio has all been very interested in it, and you, joann, would certainly be supportive of us continuing that. it's the core of what we have been doing in the last many years. >> yes, of course. and i think, following on this there are a number of opportunities here there is the chronic care focus that people are looking at what there is also a lot of discussion now about medical homes and people looking more holistically about all the services that we need to get to patience, patience centered care, and it may not be necessary the mental health person in the pediatricians office but ready access, not just, you know, not screening properly and not making sure they see someone really tracking all this and making sure patients get, the pediatricians office is sort of a model in that regard. so i think there are a lot of opportunities to integrate is an important recognition in that

area. >> and i particularly personal note, in massachusetts we have a chronic program there for many, many years, 15 years. and they took a segment, the very high utilizer's of mental illness, and high cost both physical and mental, carved them out and now new york state has followed with a program which just started a few weeks ago. and basically integrating the mental health, physical health, and all the services, all the social services within. so new york is now becoming a leader in that, because i know what you're going to find is that your costs are going to go down. the patient, the consumer is going to get better care and you're going to have a system which cost less and people

improve. it's very good you brought that up because that is happening right now, and i think as we get more data on it, it will be fascinating to watch it happen. tom, i want to talk to you about mandates. not a small topic, and obviously when we talk about mandates, there's from all of our perspective there is really two levels. mandating that the insurance companies accept patients, consumers, a regardless of their pre-existing condition. and then we need to have a discussion on mandating coverage for all americans. >> you know, we would agree that if you want to get insurance you should have it, and there shouldn't be any limits on pre-existing conditions. there should be a guaranteed issue. from our standpoint the most