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Recovery in the News
Interview with IOP Fellow Jim Ramstad
Samina Udden
The Citizen
April 29, 2009
This past semester, Congressman Jim Ramstad (R-MN; 1990-2009) was a fellow at HKS’s Institute of Politics (IOP). During his years in Congress, Ramstad was a member of the House Ways and Means Committee, Health Subcommittee, and Oversight Subcommittee. He also co-chaired the Addiction Treatment and Recovery Caucus, as well as the Bipartisan Disabilities Caucus, Law Enforcement Caucus, and Medical Technology Caucus.
While at the Kennedy School, Ramstad led a study group at the IOP called The Policy and Politics of Addiction and Mental Illness, which examined the problems of untreated mental illness and addiction in the context of health care reform. The Citizen sat down with Ramstad to discuss different health care reform models and their potential impact on access to care for mentally ill patients, national drug control policy, the veterans’ health system, and his work in Congress on behalf of the mentally ill.
Q: Why is it important for students to be aware of and understand the issue of untreated mental illness as part of the broader debate over health care reform?
A: Untreated mental illness and chemical addiction represent the number one public health problem in America today. Currently, 54 million Americans are afflicted with mental illness, while 26 million are suffering from chemical addiction. However, despite the sheer numbers, we lack an effective national strategy to deal with it.
Q: Along with Rep. Patrick Kennedy (D-RI), you co-sponsored the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in the House of Representatives. The bill was passed last October and signed into law. Tell me more about the Act and the work you did with Rep. Kennedy to build consensus around it.
A: The new law requires employer and group health plans to provide equal coverage for mental and physical ailments, enabling individuals with diseases of the brain to get treatment parity.
Enacting the law was a twelve-year effort involving numerous people. The effort originated with Senator Pete V. Domenici (R-NM) and the late Senator Paul Wellstone (D-MN). Rep. Kennedy and I were the chief co-sponsors of the bill in the House.
The bill took many years to pass, in part because some Senators did not want to merge mental health and addiction into the same bill. Addiction still suffers from stigma. There are some who disagree with the American Medical Association’s characterization of addiction as a disease; who still believe that addiction is a moral weakness. Because of intense opposition from the insurance companies, moreover, we were unable to move the bill.
In the twelve years during which my party controlled Congress, we never got a vote on the bill and had only one hearing. But things changed dramatically in 2006 when the Democrats took control and the bill was put on the fast track. Thanks to Speaker of the House Nancy Pelosi and House Majority Leader Steny Hoyer, the bill moved rapidly through three subcommittees and three full committees in the House, and then onto the floor.
But the bill was further delayed in the Senate where initially, it was joined with another bill to provide tax extenders (with the Parity bill intended as a sweetener). But the Parity bill was unable to pass this way and was ultimately coupled with the $700 bailout bill. The two bills were merged on the Senate floor and summarily passed.
Needless to say, the bill took a very circuitous route to passage. It was a long, hard road. We had to stay diligent, stay persistent, and keep trying.
Q: So with Congress and the White House controlled by the Democrats, will we soon see more action on chemical dependency legislation?
A: I’m hopeful that the new Administration will emphasize drug prevention, education, and treatment, rather than spending so much money on crop eradication, because the latter strategy is not working. Until we address the insatiable demand for drugs on the part of the American people, we will never be able to curb the supply of drugs into the United States. And the only way to address the demand for drugs is through prevention, education, and treatment.
It’s ironic that in 1971, President Nixon – who wasn’t a liberal by any means — directed approximately two-thirds of federal funding to prevention, education and treatment, and only a third to dealing with supply. But over the years, the priorities established by Nixon for the War on Drugs have changed dramatically. Now, about two-thirds of federal funding is spent on curbing supply and only one-third on addressing demand.
Q: With respect to health care reform generally, given the current recession and a projected deficit of $1 trillion, is comprehensive health care reform in the near term likely? Is expanding access for patients with diseases of the brain likely to be part of these reforms?
A: I certainly hope that integrated behavioral health care will be included among the reforms. As you point out, however, the number one stumbling block to comprehensive reform is a lack of money. It will be a big expenditure, particularly in the beginning, when the reforms are enacted. But we can’t afford not to bring the 37 million uninsured Americans into the health care system. We need to bring everyone in. And I think the way we do it is through mandatory health insurance.
To drive your motor vehicle, you must have health insurance. There’s certainly a link between driving your car and health care, so that’s sort of an obvious enforcement mechanism. And how will the indigent pay for health care? We can do that through a system of refundable tax credits and vouchers for people below the poverty level.
I really admire President Obama for taking the initiative on health care reform, despite the current economic climate. If I had to bet, it’s not going to happen this year. I hope it happens during the current term in Congress, however; in other words, in the next two years.
Q: What do you think of universal health care as an option?
A: I don’t think much of it. I don’t think the American people want government-run medicine. I think they want to maintain the nexus between their place of employment and health insurance. But we have to make an effort to provide coverage to the uninsured, otherwise the system will implode.
Q: Currently, one in four veterans who have served two or more tours in Iraq or Afghanistan is afflicted with PTSD. Given President Obama’s plan to withdraw U.S. troops from Iraq in the near term, there will soon be a surge of veterans in the U.S. with PTSD. Can the current veterans’ health system accommodate them?
A: The short answer is no. As more and more veterans return home from Iraq, we’re looking at longer waiting lists. As discussed in our study group sessions with General Barry McCaffrey and former Senator and Secretary of Veterans Affairs Max Cleland, the VA system is fundamentally sound. But it doesn’t have enough funding – that’s the problem. We should be giving higher priority to veterans’ health care in the budget.
I’ve always thought that veterans’ health care should be an entitlement, like Social Security, Medicare, and Medicaid. We owe it to our veterans to ensure that those who have made such tremendous sacrifices should get quality healthcare when they return from battle. We’re not delivering on that promise to our veterans right now.
Q: Having led a study group at the IOP this past semester, what surprised you most about the school and the students who attended your study group?
A: I was most impressed by the incredibly high level of participation of undergraduates at the IOP. During each of the study group meetings, the conference room was packed with students. The other Fellows have experienced the same thing with their study groups. It speaks very well of Harvard students, who came to the study group without the promise of extra credit or tangible reward. That surprised me more than anything – the intense interest on the part of so many students. It’s very refreshing and very encouraging as I look to the future. Our country will be in good hands with today’s college generation in charge.