What Polls Say About Our Attitude Toward Health Reform and Mental Illness

What did the politician say after bumping his head while walking along a sidewalk as he waved to his constituents?   “I never look at the poles.”

Whether political leaders admit to looking at the polls or not, when you look beyond the headlines some current polls are saying a lot about how people feel about health and mental health policy issues. 

In the spirit of post-State of the Union bipartisanship, let’s hope that President Obama and Congressional leaders use three recent polls to listen to us about health reform, and to educate us about mental illness.

First, this is what the President and members of Congress will hear if they listen to what people are telling pollsters about the health reform law.

• We like a number of the elements of health reform, and don’t want them repealed.
• We’re not afraid that health reform will affect our existing health coverage.
• We don’t think the current law went too far.

The headlines from three January polls suggest that we remain divided about the reform law, with slightly more opposing it than favoring it. 

A Rasmussen survey found that 53% of voters favor repealing the law and 43% do not.  In the most recent ABC News/Washington Post Poll, 50% said they opposed the health reform law versus 45% who favored it.  An AP-GfK poll found the public evenly split on the new law, with 41% saying they opposed it and 40% saying they favored it. 

But when we listen beyond the headlines, we hear a different voice. 

In the AP-GfK Poll, only 26% supported repealing the law in its entirety.  An earlier Rasmussen poll also found a minority for full repeal of the law – 39%. In the ABC News/Washington Post Poll, 18% said that they favored total repeal. 

Support for full repeal isn't very high, and the reason is that we like many parts of the new law.  In the AP-GfK poll, the public supported by 50%-34% the prohibition on insurers denying coverage based on pre-existing conditions (such as cancer, mental illness, diabetes, and heart disease), and by 59%-34% the prohibition on insurers cancelling coverage because someone becomes sick.

We're also not afraid that the law is going to have an adverse effect on insurance we have and like.  In the Rasmussen poll, only 34% said that they thought the law was likely to force them to change their existing coverage.  

There are also a lot of people who think that the law should go farther.  In the ABC Poll, one in four said that the reason they opposed the law was because it didn’t go far enough.  Over half of those who supported it agreed with them, also favoring a reform law that would go farther than the current one does. 

source: ABC News/Wash Post Poll 1/11

These are a lot of numbers to absorb all at once, but the bottom line is pretty straightforward, and paints a far different picture from the headline.  35% said the law went too far, 19% said it was just right, and a slight plurality – 38% - said it didn’t go far enough. 

Politicians who ignore this message do so at their own peril. 

Second, here is why the President and members of Congress need to provide leadership in educating us about mental illness in the aftermath of the Tucson tragedy.

• We believe erroneously that mental illness causes violence. 

Some people with mental illness commit violent acts, but mental illness is not usually the reason.  One quarter of our population has a diagnosable mental illness each year, and this group is no more likely to be violent than the other three quarters.  Substance abuse (but not substance abuse treatment), juvenile detention, physical abuse, and past history of violence are predictors of future violent behavior, but mental illness is not. 

We need leaders who are willing to speak that truth to us.    

As was noted by researchers at the University of Tulsa in 2008, media reporting on events like the Tucson shooting makes a difference in how people react to the event, contributes to misperceptions about people with mental illness, and deflects attention away from the actual context of violent acts.  

Leaders need to speak up before our responses to violence do more harm than good.

In the ABC News/Washington Post Poll, 83% said that they would support increasing federal funding to add people treated for mental illness to the federal gun registry in an effort to prevent them from buying guns, and 71% said that they would support this for people treated for substance abuse.

source: ABC News/Wash Post Poll 1/11

We are so scared of mental illness that 83% of us would waste precious tax dollars creating a registry that would violate the confidentiality of one quarter of our population while doing nothing to address the real causes of violence in our society.

That’s hard to understand, but I guess we all bump into polls sometimes and come up rubbing our heads.

If you like this blog, become a follower or subscribe to it, and help get the word out by sharing it with friends and associates!

The Impact of Health Reform Repeal on Florida

Why should Floridians care if members of its House of Representatives delegation vote to repeal all the provisions of health reform this week?

Because even though the Senate and the President have said they will stop the measure dead in its tracks, a vote to repeal is a vote against the interests of Floridians.

If every provision of health reform were to be repealed, here are just some of the people of Florida who would be affected:

• 86,300 young adults who would lose insurance coverage through their parents’ health insurance plans;
• 182,672 Medicare recipients in the donut hole who would be charged at least $250 more for their prescription drugs in 2011 than they were in 2010;
• Early retirees of 190 Florida employers – including the University of Miami, Stetson University, Eckerd College, the PGA Tour, Inc., The Wackenhut Corporation, Tampa General Hospital, the Archdiocese of Miami, the Escambia County Sheriff’s Office, the Florida Firefighters Insurance Trust Fund, Duvall County Public Schools, the Cities of Orlando, Miami, Jacksonville, St. Petersburg, and Fort Lauderdale, and the town of Palm Beach – who have already applied to keep their retirees on their health insurance plans (full disclosure: I also get this benefit as an early retiree of the State of Connecticut);   
• 3.2 million Florida Medicare recipients, who would have to pay out-of-pocket for an annual check-up, mammograms, and colonoscopies;
• More than 8.7 million residents with private health insurance coverage who would lose consumer protections like the ban on insurers cancelling coverage because they become sick, and the ban on insurers using pre-existing conditions as an excuse not to insure people in the first place;
• Up to 290,000 small businesses in Florida now eligible for tax credits to cover the cost of health insurance for their employees.

People and businesses in every state would experience similar impacts if the reform law were repealed.



Members of the House who cast a vote for repeal are casting a vote against these constituents.  Is casting a vote against tax credits for small businesses, health and prescription coverage for Medicare recipients, and aid for employers and their early retirees really working on behalf of constituents? If not, then whose interests are they really serving?



What To Do About Health Reform?
source: AP-GfK Poll, January, 2011



According to a new AP-GfK poll, the public emphatically does not want Congress to repeal the reform law.  We’re still evenly divided about it, with 40% saying we support it and 41% saying we oppose it.  But when we’re asked what we want to do about it, only 26% want to repeal it completely and only 10% more want it to do less.  Four times as many – 43% -- want it to do more.

In the same poll, by the way, 59% opposed the mandate that individuals buy policies if they can afford them, but 59% supported the mandate that employers offer insurance to their employees.  This perhaps proves once and for all that as a nation we love mandates, provided they’re someone else's mandates!

The bottom line is that we want more health insurance coverage, not less, and we don’t want to lose the benefits we have. 

Does this matter to our elected officials?  If they’re representing our interests, it should.  But as Jim Saunders reported in Health News Florida last week, Florida Governor Rick Scott and 31 other Governors hold a different view.  Fearing they’re not up to the job of balancing their own state budgets without help from the federal government, they want permission to ignore Medicaid “maintenance of effort” provisions in the law.  These are the provisions that assure that states will do no harm to current Medicaid recipients, including seniors and children, over the next few years.

Scott wrote that “Florida should get to determine what program is the right fit for our state in terms of a Medicaid program,” even though he’s asking the Federal government to continue to pay more than half the cost.

What does this really mean?  Governor Scott and others want the Federal money they get for Medicaid, but they also want the power to dump as many mandated benefits from the program as they can, no matter how much harm this may do. 

Is this really the direction they think they were given by voters in 2010?

Violence is a Public Health, Not a Mental Health, Problem

We were all understandably shocked by the horrifying shooting in Tucson AZ this past weekend.  A Congresswoman was critically injured, and six people, including a nine year old girl, were killed.

Media commentators have asked an important question – are public officials safe from violence anymore?  As a former public official who received threats of violence, that's a question about which I care personally.

There’s a consensus answer to it.  In our vitriolic political environment, hateful rhetoric sometimes pushes disturbed, paranoid people over the edge.  If we dial back the rhetoric and keep a closer eye on disturbed, paranoid people, we’ll all be okay.

But there’s a more important question we’re forgetting to ask that leads to a far different answer.

Who points a gun at an innocent nine year old and coldly pulls the trigger?

Tim and Mayor Paul Gionfriddo,
Middletown CT Sidewalk Sale
1990, c.Hartford Courant 

The answer to the question doesn’t fit easily into the narrative of this tragedy.   This is because shooters of nine year olds aren’t usually stoked by hateful rhetoric.  And shooters far more often target innocent nine year olds, who trust us to protect them, than they do equally innocent public officials.  

Think about this:

·        A nine year old was shot dead inside his Washington DC apartment in November, 2009, when a gunman fired through the front door. 

·        A nine year old boy was shot and injured in Brooklyn NY in June, 2010, in a dispute over a stolen bike.

·        A nine year old boy was shot and killed in an affluent gated community in Dade County FL in March, 2010.  A family member was the first identified as a "person of interest.”

·         A nine year old girl, playing on the sidewalk outside her aunt’s home in York PA, was shot in the back and killed in a drive-by shooting on Mother’s Day in May, 2010.

·         A nine year old girl was shot and killed while jumping rope in her grandmother’s front yard in Chicago IL in August, 2010.  Her seven year old sister was also shot. 

·         A nine year old Baton Rouge LA girl was shot six times as she got ready for school, and her mother was killed, in a home invasion in September, 2010.

·         A nine year old girl was shot and killed in October, 2010 while sitting in her family’s minivan in a parking lot in Davie FL.

·         A nine year old girl in Hercules CA was shot and hospitalized in critical condition when she opened her front door in December, 2010.

These are just some of the nine year olds who were recently shot in our country.  How big would the list grow if we added a longer time period, more ages, and additional weapons?  It’s not hard to imagine, because we have the data.  In 2002 alone, homicides took the lives of 250 children aged 4-11.

The reasons for these crimes – vigilantism, gang violence, family feuds, retribution, theft – are as varied as the lives of our neighbors.  These and other environmental demons are far, far more often the reasons why nine year olds get shot than are the illnesses of our brains. 

People with mental illness are more likely to be the victims of violence than its perpetrators.  A history of violence, juvenile detention, and physical abuse are stronger predictors of future violent behavior than is mental illness, but media stories linking mental illness and violence have created the mythical “paranoid, violent, mentally ill person” for people to fear – a myth the weekend shooter happened to fit.  

The poor link between mental illness and violence is not just my opinion.  You can read about it in the Federal Substance Abuse and Mental Health Services Administration Center (SAMHSA) fact sheet Violence and Mental Illness: The Facts.

Violence is a public health problem in our country.  It makes our living environment more dangerous, and shortens our lifespan.  When violence leads to sudden death, most victims can be called innocent bystanders. 

No one deserves to be shot or killed – not a Congresswoman or a child, not six people on a sunny Saturday in Arizona, not the eight children listed above, not the 250 4-11 year olds killed in 2002, and not the 4,090 children and adults killed in 2008 alone in the sixteen states participating in the CDC National Violent Death Reporting System.

Our understanding of violence as a public health problem dates back only about thirty years.  Today, we need to understand that the threat of violence is much bigger than the threat posed by one gunman in a single time and place.

Until we appreciate that we have put nine year olds in harm’s way no matter where they live, learn, and play, we will fail to learn the real lesson from the weekend’s tragedy.  We are all responsible for this environment of violence, and we had better start working together to clean up our mess before more children die.

A Grown-up Health Policy Agenda for 2011

House Speaker John Boehner said recently that Congressional Republicans will have to face raising the debt ceiling as “adults,” echoing his March, 2010 comment that they needed to behave like “grown-ups” when health reform passed. 

The passage of health insurance reform in 2010 did not solve all of our health policy problems, but passing a meaningless repeal measure in the House in January isn’t the best way for members of Congress to start putting their grown-up pants on. 

What might an actual adult health policy agenda look like in 2011?

First, federal and state officials would put more resources into public health.  Like computer anti-virus programs, public health programs work in the background, taking care of us even when we fail to take care of ourselves.  They make sure our water is pure, our neighborhoods clean, our hazardous wastes are disposed of properly, and our children are immunized.  People can argue over whether various prevention initiatives cost more or less than treatment but no grown-up can deny their effectiveness. 

Except, perhaps, some public officials.  Florida’s new governor is proposing to reduce the state’s commitment to public health by folding the State Health Department into the agency that manages the health care system.  “Potato salad,” is what an AFSCME representative called this approach.  More like mystery meat, I think.    

Second, everyone should get a $100 tax credit for athletic equipment.  If we’re going to stimulate the economy with tax cuts, why not stimulate a culture of wellness?  Taking $30 billion of the trillion dollars we’ll spend on health care reform in the coming decade and giving $100 to every citizen for a new pair of athletic shoes, a down payment on a bike or treadmill, a first baseball glove, or other athletic equipment adapted to their needs, would make a meaningful, adult policy statement about the importance of fitness in all our lives.

Third, legislators should require periodic mental health screening as part of the well-care exams of children and young adults.  Serious mental illnesses hit young people disproportionately, and hit them as aggressively as cancers, taking 25 years or more off their lives.  (See the accompanying chart and the bottom of my Health Facts and Sources page for explanations about the comparison.)

We can treat most mental illnesses effectively if we treat them early and aggressively, but we often wait until it’s too late.  One 20 minute mental health screening every five years from age five through age 30 is all it would take to get started, and we’d be on the road to a healthier nation.     

Fourth, mental illnesses should be treated like other chronic diseases, not hidden away in jails.  Would anyone support sending people with uncontrolled diabetes to jail when they go into a diabetic coma because they are being a danger to themselves?  It sounds absurd, but that’s how we treat a significant percentage of the over 25% of us diagnosed with a mental illness every year.  In 2007, Time magazine reported that the country’s largest psychiatric institution was a prison.  Others have estimated that the majority of the people in our jails have mental illnesses.  While almost any alternative would be preferable, the simplest solution is to de-criminalize mental illness, adding more community mental health services and centers and funding them adequately.

Fifth, state and federal policymakers should pass laws de-criminalizing casual drug use and drug addiction.  Pat Robertson suggested this on his show on December 16, 2010, joining a growing chorus of others, including the Justice Policy Institute, who argue that drug treatment is far better and less expensive than incarceration.  We’re still fighting and losing Richard Nixon’s War on Drugs, yet those who were born the year he declared it are turning 40 this year.   It’s time for a change.  Controlling the use of other drugs, like marijuana, the way we control prescription drugs, alcohol, or nicotine is not the same as being “for drugs,” and it’s a far more mature response to the situation we're in than hiding our heads and wishing the drug monsters away.

Sixth, Federal officials should expand the Medicare program to give everyone a medical home and pay for their free annual physical.  Wouldn’t this be a great birthday present for policymakers to give to every citizen – a partnership for health?  Congress went part way there in 2010 by including a free annual physical in the Medicare program, but this should be available to everyone, whether or not they’re privately insured.  If it’s too scary and “big brothery” for some public officials to take this one on, then at least they should provide a tax credit for people to use to pay for it themselves.       

They’re now reading the Constitution in Congress.  I hope they don’t skip over the part of Article One Section 8 that reminds Congress of its duty to provide for the general welfare – meaning the health, happiness, prosperity, and well-being of our people.