McCain vs. Obama on Mental Health & Psychology Issues

The United States is in the midst of its rite of choosing its next President. As a blog focused on mental health and psychology, we can’t help but wonder about the candidates’ commitment to mental health and psychological science. We should note that we hold no specific political agenda and endorse neither candidate at this time. Because this article is so long, we’ve provided an easy-to-read summary of our findings at they very end.

One way to determine a candidate’s position on such issues is to send out a questionnaire about mental health policy issues and ask the candidates to fill it out. This is what NAMI does (and did a year ago for the two current candidates), and you can view the responses here.

Not unexpectedly, Obama’s campaign responded by “Strongly supporting” every question asked about a mental health issue. You can’t go wrong filling it out that way, regardless of your intentions, because it means easy votes that nobody will ever hold you to if you become President. (His campaign also provided this statement when queried further about his stance on mental illness issues.)

McCain’s campaign either saw how ridiculous and transparent the survey was, or didn’t want to be painted into any corners early on, and declined to answer the questionnaire. But he did provide a statement about mental health care, a part of which I’ll quote:

Mental health is a necessary complement to physical health in all aspects of our daily lives. Fortunately, the path to greater quality and lower costs is to recognize this fact and where possible provide incentives to treat physical and behavioral health together. Chronic disease is a dominant component of the growth in spending on health care and many of our citizens with chronic illnesses have a behavioral health problem as well. For example, untreated depression raises dramatically the cost of treating the physical ailments of a diabetic. A sensible goal is to design reimbursement for taking care of the whole patient, whatever ails them, and recognize the essential role mental health treatment plays in the overall health of the patient and the reduction in physical health needs.

I have stressed the central role of personal responsibility in leading to lower health care costs. Personal fitness and better lifestyles, especially reduction in addictions of all types — food, narcotics, or cigarettes — can yield dramatic improvements in the cost of chronic illness and high‐cost medical care. We can do a better job of treating addictions, but we also have an obligation to do a better job of teaching our children the benefits of good lifestyles and the perils of addictive activities.

Good stuff, and without saying it, apparently agrees with mental health parity but stresses personal responsibility, especially in regards to addictions (suggesting maybe he wouldn’t take them as seriously as other mental health concerns).

I don’t think the questionnaire route is a very good one to determine the candidates’ stances on these issues, because politicians are used to promising everything and then delivering little (with plenty of excuses and rationalizations for not making good on their promises).

No, the better and more reliable way of looking at a candidate’s stance is simply to look at what they’ve voted for and supported in the past, and how their home states do in the area of mental health care. After all, as representatives in the Senate of their respective states, they are partially responsible for how their states approach mental healthcare.

Voting Records of McCain and Obama

We looked at the voting records of McCain and Obama in their capacity as Senators for their respective home states over the past few years to gauge their typical voting patterns on a number of issues directly relevant to mental health and psychology.

Medicare/Medicaid Bills

Mental health providers need to be adequately reimbursed for providing their services, or else they get out of the business. Medicare is a huge source of funding for mental health providers. So passage of the 2008 Medicare bill, which extended important expiring provisions under the program that improves beneficiary access to preventive and mental health services, enhances low-income benefit programs, and maintains access to care in rural areas, including pharmacy access, is a key indicator of support. The Senate passed the bill with a veto-proof override on July 15, 2008, 70 to 26. McCain did not vote on the bill, nor did Obama. They were too busy campaigning to bother to cast their votes. Cloture was needed, however, to get this bill to a vote. Obama did vote yes on the cloture vote, while McCain did not vote on cloture.

Earlier in the year, an important amendment reached the Senate that would halt the cut of certain Medicaid programs that were designed to help low-income families get themselves out of poverty, including case management services and rehabilitation services. These services were targeted at people with mental illness to help them manage their medications and live a healthy life within their communities instead of being imprisoned or hospitalized. McCain, busy again on the campaign trail, did not vote. Obama voted Yes.