[Congressional Record Volume 140, Number 25 (Wednesday, March 9, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
       HEALTH REFORM SHOULD COVER MENTAL ILLNESS, SUBSTANCE ABUSE

  The SPEAKER pro tempore (Mr. Strickland). Under the Speaker's 
announced policy of February 11, 1994, the gentleman from Michigan [Mr. 
Bonior] is recognized for 60 minutes, as the majority whip.
  Mr. BONIOR. Mr. Speaker, over the past few days, this Capitol has 
been witness to an extraordinary display of bipartisan spirit.
  A display of bipartisan spirit exactly like the one we're going to 
need in order to pass health care reform.
  But unfortunately, Mr. Speaker, this bipartisanship didn't happen on 
the floor of the House or the floor of the Senate and it hasn't 
happened yet in the committee chambers--although we're moving in that 
direction.
  This display of bipartisan spirit came from two unlikely sources.
  Over the past 2 days, two extraordinary women--former First Ladies 
Betty Ford and Rosalynn Carter--one Republican and one Democrat--have 
been working together on Capitol Hill to bring attention to two often-
ignored issues.
  Two issues that affect the lives of more Americans than cancer, 
diabetes, heart disease, and arthritis--and is just as costly.
  Those two issues are mental illness and substance abuse treatment.
  Over the past few days, Mrs. Ford and Mrs. Carter have been meeting 
with Congressional committees, sending letters and speaking out, to 
make the case that unless mental health and substance abuse treatment 
are covered by health care reform in the same way as physical health 
problems--we will never get health care costs under control.
  Mr. Speaker, the very fact that these two issues are even on the 
table are a tribute to Mrs. Ford and Mrs. Carter, because their 
pioneering work on these issues is responsible for much of the progress 
we've seen so far.
  They have both worked closely with Tipper Gore toward the goal of 
developing a strong mental health and substance abuse benefit in the 
President's health care reform bill.
  And indeed, the president's health care bill does cover mental health 
and substance abuse treatment. And in the days to come, the extent to 
which those two issues are covered will be the subject of debate on 
this floor and around Capitol Hill.
  But I would like to take a moment to talk about these issues.
  Mr. Speaker, it has been said that severe mental illnesses may not 
have telethons, poster children, or rock-star benefits but they are 
disabilities, and illnesses--just like any other.
  And they deserve to be treated the same.
  A recent study by the University of Michigan found that about three 
out of every 10 Americans suffer from depression or other forms of 
mental illness each year.
  Throughout the course of our lives, nearly half of all Americans will 
experience at least one episode of a serious emotional problem.
  Yet, two out of three people who need treatment don't get it--either 
because they can't afford to, or no treatment center is available to 
them.
  Twelve percent of our children suffer from emotional and mental 
illnesses, yet here too, two out of every three children who need 
treatment don't get it.
  Substance abuse is a problem for an estimated 11 million Americans--
yet only a fourth of them have access to treatment. There are waiting 
lists a mile long around this country of people who want to get into 
treatment programs but can't or can't afford to, even if they can get 
into a program.
  As a result, many drug users are at great risk of contracting AIDS, 
tuberculosis, or other infectious diseases.
  Mr. Speaker, this problem affects all of us.
  Substance abuse and mental illness take an enormous toll on American 
society.
  The breakdown of families, violence in our communities, and 
homelessness on the streets are just some of the problems.
  The truth is, we all pay. We pay billions to treat sickness and 
illness that could have been prevented, or treated earlier, for much 
less cost.
  Major depression is second only to cardiovascular disease as a cause 
of missed work days and lost productivity. When an employee suffering 
from depression stays home from work, he or she pays the human cost--we 
pay the financial one.
  When a father suffering from alcoholism can't give guidance to his 
children, can't hold a job, can't get health insurance, and ends up in 
intensive care because he drinks and drives--or worse, puts somebody 
else in the hospital--they pay the human cost, we pay the financial 
one.
  And when a person suffering from schizophrenia is left to wander the 
streets--like so many do--and ends up in prison for committing a crime, 
or ends up on welfare, that person pays the human cost--we pay the 
financial one.
  It has been estimated that directly and indirectly, mental illness 
and substance abuse cost this Nation over $300 billion in 1990.
  In the workplace alone, the economic costs of drug and alcohol abuse 
exceed $150 billion a year.
  The American Medical Association estimates that alcohol and drug 
dependence is responsible for 40 percent of all hospitalizations and 
one fifth of all Medicaid expenses and it's the most expensive kind of 
treatment, because it usually begins in the emergency room.
  Mr. Speaker, this problem affects us all. We can ignore the problem, 
but it's not going to go away--it's going to fester and grow.
  Unless we do something to rein in these costs, to solve this problem, 
we'll never get our health care system under control.
  Don't just take my word for it, Mr. Speaker. The American people feel 
the same way.
  A national poll released 2 days found that 62 percent of Americans 
believe that mental health and substance abuse treatment must be part 
of comprehensive health care reform.
  And a recent Gallup Poll indicated that over 70 percent of Americans 
believe that alcohol and drug dependence is a disease that should be 
treated in a hospital or health care institution.
  As former Iowa Senator Harold Hughes, who himself is a recovering 
alcoholic, pointed out in a hearing yesterday, for centuries, there was 
no treatment, no help, nowhere for people who suffered from mental 
illness or substance abuse to turn.
  Tens of thousands of people have rotted in jails, prisons, insane 
asylums, and in streets because of neglect.
  Millions more have been turned down for jobs, turned away from 
housing, turned out from insurance companies, and denied the 
opportunity to rebuild their lives in the community.
  And it still happens. But not because we don't know any better.
  We know what works. We know what kind of treatment works.
  Research has made it clear, for example, that many major mental 
illnesses are related to chemical or structural problems of the brain. 
They are just like physical illnesses.
  We know that many suicides, homicides, and accidents--the leading 
causes of death in adolescents--can be prevented with proper treatment.
  With treatment, for example, the success rate for treatment of 
schizophrenia, when done right, is 60 percent. For panic disorders, 
it's 80 percent. For manic-depressive illness, it's also 80 percent.
  Compare that to the success rate for angioplasty--which is 41 
percent.
  Companies are finding more and more that when they address mental 
illness and substance abuse rather than ignoring it--they get results.
  McDonnell Douglas is a good example.
  In 1989, McDonnell Douglas introduced a managed mental health 
employee assistance plan. Their plan focused on each individual 
patient, on a case-by-case basis, and managed long-term care.
  During the first year, they reduced their per capita cost by 34 
percent. Psychiatric inpatient costs decreased by 50 percent and 
chemical dependency costs dropped 29 percent.
  And overall, employee absenteeism is lower and turnover rates were 
reduced.
  These results have been repeated time and time again at companies 
like Federal Express, Digital, Honeywell, and First National Bank of 
Chicago--all of them have success stories.
  All of them have taken the time to treat mental illness and substance 
abuse just like any other physical illness to make prevention and 
treatment a priority and in doing so, they've not only saved money, 
they've saved lives.
  Mr. Speaker, I agree with former First Ladies Betty Ford and Rosalynn 
Carter, who have done such a good job to raise awareness on these 
issues.
  The current debate over health care reform offers us an unprecedented 
opportunity to improve the lives of millions of Americans.
  Every single year, substance abuse and mental illness cost our 
society more than cancer, lung disease, or heart disease. No one argues 
that we should not treat those diseases, or that we should treat them 
partially.
  And no one can argue that mental illness and substance abuse 
treatment should be left off the table again.
  We can't afford to treat either one as second-class illnesses any 
longer. Alcohol and drug abuse and mental illness must be treated just 
like any other physical illness.
  And later this year, when we pass legislation providing all Americans 
with guaranteed private health insurance that can never be taken away 
they must be an equal part of the final package.

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