good. . the idea of whether they're talking about single payer, the public plan verses the insurance reform. we want to have mandates or not? it is not happening.

one in four say they are following this debate closely. >> let's now talk about specifically public opinion on mental-health and mental illness. the bottom line question that i would have, and i did some polling for the american psychological association and for mtv when they did a series of public service ads on depression and suicide for teenagers, the bottom line question that i had is what americans think about health care reform, they even think about mental health? the subcommittee have any -- lisa, the have any evidence? >> i think generally when the public thinks about health care reform, they're thinking about it through their own lands. for most of them, that lens is cost. they're doing their checkbook

calculations for it if their family member has a mental health condition, then that factors in. i don't think they're speaking about the specific issues. again, we looked at it more generally. >> kaiser is a lot of public policy and appalling. roughly 8% of americans have cited they have had a mental health issues in the last year that they have not been able to treat because of cost. about 65%-75% said the condition got worse as a consequence. the percentage of getting worse is one of the highest of the mental health issues because of the lack of treatment. we have about 40% of the people in the country about the present issue and i think this is the connective tissue.

a majority of the country says that either someone in their family or a very close friend has had an alcohol, drug, or significant presence issue. -- significant depressant issure. have one suggestion on how to translate those percentages. i do seatbelt said it -- seat belt safety. i broke with my party and fought over the country for seat belt laws. it had a substantial effect. we asked parents how to secure their kids. 6% said they did not secure them in the car at all. they know the socialized response is going to be, so when 6% say they denied harness their children, that means at least

6%. we had 80 million children in our country, and that is four. million children. if every day we're driving, there are 5 million children whose parents are not alleging that they did not secure them in the car. when we change the dialogue from 6% to 5 million, the press said it was bigger than the washington dc metro area. we qaeda drew a circle around a press conference and said here is how big the radius would be around this town. it would cover 5 million children whose parents and knowledge they have never secured them in the car. women did the press conference with the bull's-eye, the big circle for how broad you have to go, if you get to major mature american, 5 million people takes a pretty big circle. when you are in the mountain west, and you draw 5 million children circle, that is a lot of america. these are things that we did to

make a dramatic for people the risk and who we were leaving untouched by not having a mandatory seat belt laws. again, of course there are very tragic stories about what happens when kids are unsecured and cars. the combined personal story -- if you combine a personal story and try to find ways to connect and show the human face and just the scope. all those things are much more powerful than talking about percentages. >> one thing that i have noticed over time being on the inside of government as a pollster is that people tend to use too many numbers. if you are using four numbers in a paragraph or on a single page, people are going to walk away and remember nut -- none of those numbers. if you find the right number, then i think you are right -- much more likely to have success. >> to get what mr. gore was

talking about, the overall stigma and try to change not just policy but how people feel about something. what bill was talking about getting a brought home for them, for them to see the connection, those numbers do not multiply. the internet and everyone traveling all over, the connection gets even closer because they're more apt to some as someone who is a in a different situation from them, more apt to know people with different health of elections. that is why there are a lot of different groups talking about the sort things all of these diseases that were not tough enough fibers ago now have organizations. -- that were not talked about five years ago now have organizations. policy is a different thing. if you look at the public opinion numbers and pulls in different states were mental-

health parity issues are coming out, there is not that i have seen in any of the polling saying that they support that. also, the have not picked up anything underlying that in focus groups on health care. i have done dozens over the past two years. i haven't heard anything more people say this disease is important, this disease is not. i think one of the things on how to use this in campaigns is that i have used mental-health parity in several campaigns where people are looking for something to grab onto. they didn't say to make sure there were helping this group or did it for mental health parity. you stood up to people who wanted to let the insurers deny and make sure how to deny coverage. it went to deny coverage to people who needed it. the idea is that some of the rising tide that can help police

to get into the door and pushed the message that the need for equal treatment which is sending the people do believe in. the more we get into specifics, i think it is harder to expect candidates to campaign on that and put that on the air for a specific issue not because it is not important but because the 10% of the people in that poll said they were affected directly, but still when you can broaden it and include everyone, he argues that in your campaign. >> let's get even more specific on this message. the goal of this group here, i am sure in the next several months as we go through this health care reform exercise and as one who has the scars from the clinton health-care reform exercise, i know these folks are in for. the once a major mental health

is an integral part of the package, the quality goes up, services are more accessible. tell what this group what to say. tell them how to approach the issue, use the right words in. >> here is my thought. we did do some work in 2001 and interviewed family physicians. 73% said that they did do depression are mental health screenings as part of a routine check. there's a powerful momentum for preventive and wallace. -- a preventive and wellness. there is a roaring current than trying to build a new pathway. my instincts are to look at

prevention and wellness, to make mental health under the rubrick and the need to do under prevention and wellness. the need to have a message of optimism and hope. it transforms lives. a treatment transforms lives in a way from survey data. we took data from people with chronic depression verses those who have had a mild depression and those who went untraded. if you look at the people who have had chronic episodes and you look at divorce, education, medicaid, they are not able to work. i can tell from numbers the human story that is there. you need to sell people that this stuff makes a difference and ultimately as -- and ultimately it is connected to these diseases and is cheaper. we asked people this question and retracted overtime. is depression a state of mind or is it a disease?

it is very, very clear that people see it as a disease, their attitudes about coverage change and they have enormous a different attitude. i think learning to talk about this as a treatable disease like other diseases, that is pivotal to winning these arguments. those are two or three things that i would instinctively think about in terms of what has to be done. i would just say this, again, having been through this, we have to fight first about the structure and then get to the benefit package. like a lot of other advocacy groups, the fight we are in now, it is hard to be in that fight because we're not the point where we're talking about what would be in the plants. we're talking about what the structure would be. it is not surprising to me that you would feel frustrated that it is hard to kind of get your foot in the door in terms of this discussion at this point. >> what did you find out about

preventive care? >> preventive care is not wildly popular with the public. people see that makes sense. even though it is hard to document cost savings for press -- for specific types, the goods they could save money through this, have the believe -- have the people lead happier, healthier lives. i think it is important to frame it as a basic part of prevention and wellness, having been helping people be happier, healthier, more productive on the job. with talking to the public on this or on anything, it is important to stay away from talking about systemic reform. talk about it in terms of the patient and his or her doctor, because again that is how people think about things. i think to bill's point, as

people start talking about the benefits package and everything that overlays this is the financing and the current economic climate. you're financing sources are very controversial and hard to find. to the degree that there are ways to highlight cost savings both to help your overall and in terms of productivity for employers or individuals, that is a good tactic to take because it is on the top of the mines for many members of congress. >> i have been hardened by how preventive care and wallace are excepted by people in the do not have to give evidence of the numbers -- preventive care and wellness. people trusted. well this plans will say people money. -- wellness plans will say people money.

there are dressing more of the structure in systemic reforms. wellness program as they can understand. they already know a story. that could be something. i think the other thing, again, looking to what you want to get out of the debate, as bill said, the elephants and adoptees are fighting. -- the elephants and donkeys are fighting. there should be no denial of benefits for not only mental- health the you get more broadly say we should, as we are looking in insurance reform, now that insurance companies, not the bureaucrats make those decisions on what sort of care we get. that is something that i think has attraction it is part of the message that did not work at times, but it has been used politically for the patient's bill of rights, the idea of just

letting your doctor make decisions, not bureaucrats. >> they believe wellness is cost savings. they have a very impressive responsibility which is that they've "score" these reforms. they have to look at the index, the federal budget will be. there's not a time where the congressional budget office has expanded didn't prevention and wellness -- has expanded prevention and wellness programs. it is one of the huge gaps between what americans intuitively believe and what the budget office is willing to score. it is a problem because it is

hard. it is really hard to get the money devoted to those programs because you get zero credit for it as a reformer and because the budget office will not score it that way. i want to make sure that this view are fighting hard every day on her behalf, that is why it is hard. it does not score that way. >> i think we have won a vintage right now in seeking this and that is peter orzag for the last several years, when he was head of the congressional budget office and now has identified as a health -- and identified health care as the number one culprit in economic growth. having him there makes some difference read exactly what difference that will make on funding wellness programs and preventative programs is anyone's guess. >> the cautionary note on the

other side, you look at scoring and the c.b.o, just to say something we had the beginning, just how little is understood by the public. preventive wellness care, people knew those extensively in it did not have to be persuaded a bottom. they already believed there were good things. a lot of the good terms that you in this year room use of the time -- you in this room is all the time, is not that they're not understood, but they're completely misunderstood. we were in focus groups last summer and testing terms like single payer. people would say i hate single pair. i would pay my insurance company and they keep the money. we stopped asking the same questions because you finally proven yourself that people do not understand it. usually there was only one or two people in the group is a single payer is this and they would get everyone on track people -- they would get

everyone on track. they would just miss understand it. then all sorts of different ideas. other groups continue to use this and i think they're not doing any polling or for reserves -- polling or focus groups. they might not know the answer. people cannot understand a lot of the terms we use. even now, i wonder how many people have an idea what a public plan is. maybe realize that is something for the government that they take care. the idea that they think is going to be government run health care even though it isn't an option, it is something they may not have even thought about yen alone have a strong opinion on. >> so, what i am seeing here is

an advertisement of someone with a health and mental -- a mental health program standing up looking into the camera. you can spend $44 to keep healthy for the next year or you cannot spend that money and will cost you $15,000 in two weeks in hospital. >> that is a bummer. [laughter] >> i'm trying to get to the personal side and the cost side. >> what i would save and obviously, you know, the end of the spot is "and now i'm back to work, paying taxes, and taking care of my family." you want to paint a choice that says -- that is the sort of thing you really deal with. even talking to and doing this research with patients.

but this as i am not cured. i am dealing with a lifelong habit and a problem that i have to keep trading. -- treating. choice, control, competition and secure. -- and cures. a lot of disease groups can talk about cures. realistically your patience to we'll talk to do not use that word. the point is my talk about hope and optimism as a way to compel action, they are not going to say i am cured, they're going to say they are better and doing this and that. if you take that spot, you want to pay division because people want advocacy. again, i do not to sound

terrible, but there are incredibly heartbreaking stories about africa, aids. you save that it will never get better. you could spend hundreds of billions of dollars and will never get better. it is a barrier to action. on taking your commercial and ending it so there is a better option to people understand that that modest amounts of money transforms not only his or her life but it provides a way to make sure that others have and can do something that has this advocatious ending. >> now you know why he was so successful in this business. [laughter] other comments on this? by now we take a couple of questions from the audience. i do not know if there is a mine, but if people are interested in asking questions. ma'am?

>> i am a psychiatrist and a move from dallas to arkansas. i was wondering moving to the united states we only have dr. phil to teach psychology. why do we not have media as a platform in the u.s.? by the professionals in my profession run from the media? -- why do professionals in my profession run from the media? why don't we use more mtv for raising our kids? >> the question is about the use of media in identifying these

problems and a defining them. and why there is no more coverage of these issues here. >> i think part of this is the culture. it is always important in a medical setting, but the culture of their be in psychology is that patients privacies are huge concerns because the sensitivity of patience. it creates a monologue of the practitioners inappropriate, deeply rooted sense for the need for personal privacy. i think that can spillover in terms of how visible and how much they feel comfortable in an advocacy role. it is hard when you are a physician, it is hard for you to tell some of these personal vignettes because a lot of people here themselves in them. they wonder if you're talking about them. my guess would be that that could be a contributor. two, the other thing that was

interesting, the explosion of disease and advocacy groups in this era. it is a constant battle with a lot of other stuff. i would say, having looked at the data, when you do those cancer, heart attack, some of these other diseases, diabetes, there is a connection rate. this connection rates aren't 7% -- those are 70%, 80%. when we did the personal connection to depression, there were very different results based on education the nice thing is that you can do better. there is a window in 1993-1994 where they changed health care. like you heard the conference, i

love the story about how powerful is. during this window, it is appropriate you're going to be asked to crank up in a way. these windows open about once every 15-20 years. if they do not get done, we will wait every other -- we will wait another very long time. the next few months of the president's administration, this is critical to finding a lot of our health-care system. we either change, or if it does not change, believe me it will not come up again for another very long time. >> that is a cheerful fog. i do not have anything to add. -- that is a cheerful thought. >> not to put in a plug for what i do, but i do think that online connections to the younger people in particular can work

and youtube is watched by more than a few people. unfortunately, if you look at a for more than half an hour you wonder about the sanity of the entire world's population. [laughter] other questions? >> i served on the board here. thank you for coming. having bipolar disorder, i am not just better. [applause] my question is what you guys see in the park -- in terms of the product care model. diabetes, asthma, any other carrier you look at in talking about prevention and chronic care that we're not on the preventive and we're also dealing with the worsening of symptoms want to have a diagnosis i.

how can that be part of the discussions only talk about healthcare reform? >> as we mentioned the idea of prevention and wellness is very important to the public. if someone has diabetes and can self monitor his or her condition and treated, it costs a lot less and has far better outcomes if you put off carom to when you have to have your leg amputated. the messages about the positive aspects. wellness is definitely a positive step we can take. when the more powerful messages to emerge is the idea that your insurance company should not be able to deny treatment because your 65 years ago where a child has asthma or your of a certain age. i think hitting those refrains when your messaging to the public and talking about a, it is sending the resonates and people understand both from it making sense without it getting into the number of dollars that

goes to chronic care management and could, and just highlighting the potential in terms of the wellness and cost savings. >> that is an example of the sort of approach we should have. it is not just about this condition, not just about mental health, but when you link it to diabetes, certain people are expanded greatly in giving people something, it is quicker to understand the idea. they did not -- do not think everyone knows when you say chronic care that everyone knows what's that mean -- knows what that means. the doocy people have conditions that are treatable but cannot necessarily be cured like these in june not know about the way you interact with these different groups, the message to other people that the more you have of these examples, the more is inclusive and the more they

understand. >> let's take one last question here. >> when you talk about cost saving, by see cost savings at one level as a really good discussion, but at the state level it is actually a little frightening to be talking about cost savings because it is almost like you're giving them permission to take money away from mental health services when you say we can save you money if you do this and this. now, i would say across the country, but certainly in georgia or mental health is already been so horribly underfunded, cost savings is not really what i am talking about. i'm talking about taking that money and doing a much better job with it. i do not want them to talk -- to stop spending the little they are spending. how you craft a message that says we do better without saying cost savings. i already say the many use