the presiding officer: the majority leader. mr. reid: i ask that the quoarp call be terminated. officer woiks. mr. reid: i ask that the majority leader be authorized to sign any resolutions from montana tai june 15 to thursday, june 1.

i ask that the senate adjourn until 10:00 a.m. tomorrow morning. following the prayer and pledge, the journal of proceedings be approved to date, the the morning hour be deemed expired, toot time for the two leaders be reserved for their use later in the day and thereby a period of morning business with the time equally divided and controlled between the two leaders or their designees, with the majority controlling the first half and the republicans controlling the final half. the senators permitted to speak for up to 10 minutes each. i ask that the senate recess from 12:30 tomorrow until 2:15 p.m. t to allow for the weekly party caucus luncheons. the presiding officer: without objection. mr. reid: following morning business, the senate will resume the motion to proceed to s. 1123. there will be one hour of debate fryer a cloture vote. the senators should expect the cloture vote to occur as early as 11:45 tomorrow. if there's no further birks i ask that we stand adjourned under the previous order. the presiding officer: the senate stands adjourned until 10:00 a.m. tomorrow.

now political and health policy analysts has legislation to reconstruction the industry and changes needed in mental-health field this event was part of a conference hosted by the group mental-health america. [cheers and applause]. >> on behalf of the panel, i want to say thank you mental health of america for and by seen us, this is a massively timely subjects particularly in the view of the last panel.

i think this fits with where all of us wanted to focus our time and energy and particularly the next few months and i think you're going to get a feel for that during the debate today. this is not just say, an educational or process for me is a personal journey. when i was in buffalo, my uncle -- he was head of buffalo state hospital. and i have a family member receiving shock treatment for depression and in other family members who was severely mentally ill and receiving treatment and have a very challenging time until she received the modern medication.

i went on to cleveland to train and then was in the navy during the vietnam. and, lieutenant cmdr helping and the veterans returning veterans dealing with the emotional issues through the war. i have been in business all of my life. i went into business because i found it hard to have, i didn't find the adequate services that i felt my patients and others needed. so i developed hospital help and then went into the insurance business and develop services for the needy. i have always had a particular interest in serving the underserved. yes, we have had a challenge and that health reform was not past several years ago. but we cannot let that bother us. we must move of forward.

this is a time break now, this is a most unusual time where we have the president, the congress and the public will not to pass this, and we hope that this panel today will in latin 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. then i want to talk about the government sponsored program, and the newly discussed options. >> sure, it is a pleasure to be here again before you all. i think that all of us in one way or another have been touched by mental illness. and, i am certainly no exception. i want to think tipper gore for leading us off. i missed her she is such a back to foul i think we should reverse that and the future.

but let me get straight to your question. i am actually more optimistic than i have ever been about the prospect of health form. having said that i always say that healthcare is always more unlikely than it is likely but it is more likely than it ever has been. and, i look at all the different reasons as to why but i think it is important that you know these reasons. and then i am going to talked specifically, which feeds into why i am optimistic. 1i think that you're sang in the policy discussion is much more open.

>> why i am more encouraged that a gas integrated. *dais dais h* it gets integrated. the process will not be president germans days the

chairman's plan in me will be our plan because this is a process that is being worked out on capitol hill with members on both sides of the aisle getting very invested in what the policy is a very important difference in what we've tried the last time around where we had a proposal that people shot up. now the members of congress have a general vision of what the president is looking for, provide significant resources then he provides what i would suggest air cover to keep pushing the public to push the congress to act and it does what it does which is legislate. the last thing i will mention as to why i am more optimistic than ever and we can talk about the discussion of challenges and opportunities for the mental health community but there is an issue of the stake holders

sometime in washington or outside called the special interest and in this context the stakeholders are as invested if not more than getting something done. there say the current market share is declining whether the health plan, pharmaceutical industry, they say people can no longer for their stations for their products but just as important is the analysis of what we call the baseline which will have been in the future if we don't act? no longer is failure the sec and best option because they know in two years if you look at the budget toward deficit we will have a substantial conversation about debts and deficits and if we don't take advantage of this opportunity to pass health care legislation and use the reforms that everybody knows we need to do to constrain

cost three invest in the health-care system but not deficit or tax cuts come of that is a far better deal for them and their interests than waiting two years down the road to of a deficit on discussion and have a talk about cost that we have in the '80s and '90s for cuyama optimistic that it is always more likely than unlikely. >> could you comment? the key element to this plan as 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 that would compete with the four and a not-for-profit health-care plan. can you give us your thoughts? >> let me back up we come to the debate with the goal of

bringing down costs and making coverage more affordable and available. you may ask why unions have the need for health-care reform most members have good benefits but year after year this is the most difficult issue to solve with contract negotiations broke more than 10 years of health plans to improve quality and get better value for spending we have tried purchasing power programs with unions but we cannot solve at the bargaining table or on our own. we need a national solution and in order to lower their cost we have to get everyone into the system, they understand their premiums are brief elected on uncompensated care they understand they spend more than they need to and not enough value. we come to the health care reform debate wanting to see everyone covered, access to benefits made affordable to

everyone the key piece is alongside private insurance option to inject competition, lower costs, be a standard consumers can go to. it is not just in name, a convene and principal or a philosophical divide, some of what you have heard are happy that there is a recognition their needs to be a public plan and a debate of how to define it or structure it. >> representing the american health plan insurance health plan organization come at you have a strong opinion? >> yes. want to start by thanking mental-health america for the invitation to join you. i went to share it regrets that she could not be here and she is at a meeting on the

hill. period and louise are gone you will not see them this time around [applause] for the past couple of years we have been working with our board on an intensive effort to look at health care reform and look at what is really needed to get folks access to affordable coverage and that has been our goal. i just want to follow on a couple things that chris said the last couple of years i have been working on mental health parity and working on the effort to get it through and there is really three components. there was a strong push from the communities from the grassroots telling the politicians and telling us that something needs to be

done. we are starting to see that duplicated. second, champions with mental health parity you have paul wellstone and patrick kennedy, pete domenici and others who were willing to take ownership and see it got pushed through and obviously you see that now with the president and congress having a strong commitment. finally you see the stakeholders or the special interest and i don't use that term pejoratively it is patient at this stage advocacy groups employers that pick up the bulk of the cost and others saying we want to get this done. we want to get it solved and we will sit in a room until that happens. i am also very optimistic you will see something accomplished but there are

some very big issues that need to be resolved in dealing with the underlying cost is one of them, figuring out how you pay for all of this and the other is the government plan. the our plans, the president says the few are happy with the health care you have now, you get to keep it we will not blowup the current system that we have. in fact, most people who have insurance have it through their employer and most to have insurance coverage are happy. it is not perfect and there are frustrations, a lot of folks who don't have coverage that need access but the central theme needs to be let's not destroy what we have more order to fix the overall problem but with the government plan over time you

shift people into that plan provide government plan because of the breadth and depth of it can dominate the market. if you look at for example, the kennedy bill that was just introduced, they look at medicare rates plus 10% on the commercial side we typically pay 20 and 30% over medicare. if you are an employer with the underlying cost structure it makes more sense to shift everybody to the government plan. that in turn shows a lot of cost back onto the commercial side because now we know with medicare and it medicaid with the reimbursement rates that cost is on the commercial side. rethink a government plan by the very nature is not as nimble or flexible in terms of recognizing medical advances

and a new benefit design. you have a package that the government says this is what we will cover these other doctors you get to go to. i think in terms of a government plan, there is a lot of concerns it will become the dominant market player and we can what we have now that is working and not really help those folks who need access to affordable coverage. >> if it meant getting something past, but will the afl-cio go along with not having a government plan? >> i again, it is not coming it is the total package what we can achieve to cover everyone the delivery system will improve quality and better value for spending and bring down costs to affect the future trend that slows family

budgets, business and federal budgets itself. at the end we have to look at if it achieves those goals and rethink the public health insurance option is sent with that. >> speaking for a few minutes on the cooperatives and do work with the orange growers and other cooperatives in america and i am joking. [laughter] i thought at least we should spend a few minutes on it because it is out there. senator conrad brought it up as you know, from north dakota and can you give us a few minutes? >> not particularly. i would rather have one of my colleagues here who is closer to that conversation but let me set it up with a sense to a bridge to many of the concerns that people fear that i think

you will take us to in just a second so what about mental health? i am struck is a comparison with 1993 and today the contrast between we know now that was not going to happen on the one hand. on the other hand, we have a task force led by mrs. gore focusing 100% on mental health issues but this time around these folks are much more knowledgeable seem to think it will happen and i cannot identify one person who is in all the central in these conversations. it is not necessarily a bad things that parity has now been established and a lot of the land. but i still gets a little nervous because the most recent piece of big legislation that i have passed, the recovery act, if you said one doesn't and economic

depression -- depression has anything like clinical depression, how much specific to mental health was there in the recovery act? o. how i remain a little concerned about all of this as the other reason why, why i don't get really scared about the absence of specifics one of the things that is crucial to the approach that has been emphasized come at the first level about creating a broad framework that will address issues of benefits broadly and a delivery system broad labor costs of not having details about mental health is not necessarily a bad thing. but to the advocacy we will all be involved later down the road, i will make one point*. most people never see a mental health specialist for their

condition. bay go see a pediatrician, a family medicine, gp and if we just take the case of the mental health condition as 398 days reliably diagnosed and effectively treated 75% of the time, a depression, generally it is identified less than half the time and less than half when identified is it treated responsibly. so not necessarily right now because it may muddy the waters but at some point*, we have to get involved in a conversation about, what about this? >> it is the point*. you are leading us right into it. we want to ask crass who is -- chris, who is leading? and how can we be sure mental

health is covered in the comprehensive integrated manner for all citizens? >> i will do that. i will put a final point* on the public plan, and i think almost inevitably there will be something called a public plan option at the end of the day. and the debate will be very important to health plans and providers and manufacturers about what that is and how it is structured. i think this discussion is important and relevant and has served as as an extraordinary distraction over the millions of other issues upon the health care reform today. in some ways that has been constructive and some ways it has not buy predict there will be something, a god knows what

it will be. but come at the end of the day it will not be the fundamental most important part of the health care reform today and certainly not the mental health community. let me transmits -- transition. first of all, i suggest you deserve an extraordinary amount of acknowledgement and credit for your work on the non parity legislation because it sets it you up on the broader discussion. in other words, now, if there is a discussion no matter what you are automatically included and that is a brandy's. you don't have to worry about that. and as we know for people who we know and love much of the medicaid system is mental health and much of that is medicaid and much of the

problems of the populations that afflicted with mental illness is lower income people. this is a really important point* of the health-care debate. when we talk about delivery change and reform and when people are discussing in washington all people talk about is the prevention of and care for the chronically ill. right? who is a mentally ill? who were those people? that is your issue. you should own at that issue. i suspect you will you just need to make sure, by the way, you should say don't act as though mental illness is an issue independent of or somehow out of the broader debate, it is fully integrated and must we addressed as such protests you do that, you are

saying that you are right senator so when so or congress man so and so, this is the biggest issue, mental illness 512 do prevention right, you must do this progress ynez you use that as a strategy as the best that you can, you are attaching your train car to the in gin. that's is what you need to do on all of these issues. >> the kind of foundation did a terrific study that basically said by bringing the uninsured or as many as you can into the medicaid program and expanding its you would save massive amounts of money and we would get a system which is already working and organize, how do you feel about that? >> i want to come back with what chris said and

4v, the -- for me it seems counter intuitive but the focus on what exactly the mechanism will be is a secondary because the most important thing there is a robust approach to reform that has the common-sense elements but to reinforce the point* that chris has talked about where we sit, what a message that will this and prevention and are now understood by the american public and increasingly buy 80 elected officials as central to healthcare reform. is that on the sweet spot of mental health america? how does that fail? i guess dr. q'uaran kessler will -- dr. kessler will talk about the average person in the course of their life will experience a mental disorder will experience by age 14 and

the average lifetime before first having symptoms and getting care is nine years in the united states of america of. the understanding of untreated mental depression can interrupt the moms ability to turn on those receptors in a baby's brain that is critical to developing that relationship and that can lead to behavioral problems and they conducted disorder which we understand at a scientific link their reports out about prevention and just out about depression and and young people and adults and this is a timely. the question of how we make the sale i like the metaphor of cocaine that car to that train. our message in this

community, we have to get more clear about but a message to prevention and wellness and the centrality the surgeon general said mental health is the essential to overall health, that has to be what we focus on. >> there has been interesting studies that showed a significant installments of quote -- mental-health affects physical health and if you look up the cost of treating depression, heart disease, diabetes, cancer, by treating the mental bell that -- illness the cost goes down and it is a powerful argument. >> i know from my mom who lived with diabetes and depression, when she was not taking care of the depression there was no way she would take blood sugar levels. no way. this goes from me to something else that may be is premature t