Hillary Clinton's work: step by hard step toward the big goal.

AuthorSargent, Greg
PositionSpecial Report on Mental Health

As Hillary Clinton campaigns for the presidency, she frequently invokes her well-known role in crafting her husband's ill-fated 1993 health care plan, to demonstrate to progressives who remain uncertain about her ideological instincts that she has faithfully advocated for universal health care for more than two decades.

But it should also be remembered that as part of that effort, Clinton also pushed for broad reforms to how our nation treats--or mistreats--people with mental illness. It's a cause she has championed for just as long.

Early on, as the leader of the Clinton administration's health care task force, the first lady enlisted Tipper Gore, wife of Vice President A1 Gore, to serve as its mental health adviser. Tipper, who had a master's degree in psychology and had long been involved in mental health advocacy, due in part to her own bouts of depression, recommended a policy of "parity"--that is, that the government should require insurance plans to offer coverage on an equal basis to both physical and mental illness. Gore articulated the problem in simple terms: "Why should a woman with diabetes who needs insulin have it covered by insurance, whereas a woman with manic-depressive illness who needs lithium not be covered in the same way, when both diseases can be managed and controlled?"

At the time, Hillary Clinton agreed. "It's a problem that permeates the whole system," she said. "We have to do something. I don't think there is a choice anymore." Mental health practitioners and advocates were ecstatic. As Congressional Quarterly put it, "For the first time in history, they see a chance that mental illness will get the same insurance coverage as physical illnesses."

As we all know, this entire effort came crashing down, due to industry and congressional opposition, as well as Hillary Clinton's own miscalculations. The chastened first lady retreated from her push for health care reform--mental health reform included.

Or, at least, so it seemed. The full story is that, starting in the mid-1990s and continuing for the next two decades, Clinton kept up the fight, both in public and behind the scenes, for parity. And it paid off with a series of small-bore advances that--while there's still a long way to go--have added up. That narrative sheds light on the continuing challenges presented by the parity issue, and usefully illustrates Clinton's broader public philosophy--that is, that incremental reform is worth fighting for, and can...

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