Insight Matters
Spring, 2003

Proponent Testimony - H.B. 33
Presented to the House Insurance Committee on May 6, 2003
By Sul Ross Thorward, M.D., representing the Coalition for Healthy Communities, the Ohio State Medical Association, and the Ohio Psychiatric Association

I am here to talk to you about a huge gap in basic health care in the State of Ohio. I am here to speak to you about ending discrimination in our health-care laws. I am here in support of Rep. Olman's House Bill 33. Basic health care is mandated in Ohio and should cover all the major organ systems in the human body. It does not. Ohio leaves major systems of the human brain uncovered, excluded or poorly covered. HB 33 will correct this error.

Most of us have purchased appliances at one time or another. Most of us expect that appliances are covered by a full guarantee or warranty at the time that we buy them. Suppose for a minute that you purchase a new radio. You bring the radio home only to
discover it does not operate properly. It plays too loudly. Whenever the volume is adjusted, the radio will not turn below a distorting, ear-blasting level. Believing that you have a valid warranty, you take the radio back to the store. Much to your surprise, when you ask for the radio to be replaced, the store manager tells you he is sorry. Radios are under full warranty for volume problems only if they play too softly. There is only a limited warranty if the radio plays too loudly. In other words, if your radio will not play above a whisper it can be replaced no questions asked. But, since the problem is that the radio plays too loudly, the warranty only assures half the cost of the radio towards the purchase of a replacement. Most of us think this situation absurd. Nevertheless, let me take a minute to explain that we insure one of the most critical organs in our body - the brain - in exactly that same absurd manner.

The substantia nigra is a region of the brain which contains neurons that produce the neurotransmitter dopamine. It is black in appearance, giving rise to the name ("substantia nigra" is Latin for "black substance.") Neurons in the substantia nigra travel to brain areas which are important for motor control as well as to the frontal lobes, which are important for attention and executive function. Attention and executive function are major problems in schizophrenia. Parkinson's disease is a disorder that involves progressive death of neurons in the substantia nigra, leading to motor and cognitive symptoms.

It is a very critical part of the brain having many functions which are not unlike the volume control in the radio. Dysfunction in this part of the brain can seriously affect chemical transmission carried out by a substance called dopamine. Several important pathways which control movement, thought, and perception begin in this group of cells.

You are all familiar with Muhammed Ali and Michael J. Fox, who are both diagnosed with Parkinson's disease. Basic health-care medical insurance will cover all standard treatments of this major brain disorder. The problem is that the volume is too low, and can't be turned up. There is not enough dopamine transmission. This disease is treated by turning up the "volume" of dopamine transmission through the use of medications. No implications are made that this illness is the patient's fault. Poor will, poor spirit or poor choices (such as the intentional exposure to head trauma experienced by a professional boxer) are not invoked as reasons to limit coverage. Insurance is expected to operate to the full limits of the policy.

A similar problem in the same system occurs if the "volume" is too high. When there is too much dopamine transmission, a brain disorder Schizophrenia results rather than Parkinson's disease. Schizophrenia is a disorder of thought and perception. It is treated by turning down the "volume" of dopamine transmission through the use of medications. In this situation, just like with the radio, an Ohio resident will be informed that their brain is insured differently in this situation. Increased co-pays and increased limits of benefits are required when there is too much dopamine activity rather than too little.

Similar restrictions apply in multiple other disorders including major depression, the second leading cause of disability in the United States and panic disorder, a major cause of unnecessary medical expenditures in the United States.

Further - treatment works! The treatment results for these disorders exceed those for many standard medical treatments such as angioplasty and artherectomy. Clinical trials testify to the effectiveness of psychiatric treatment for many illnesses. (See page 6.)

Examples include:

• Major depression can be treated successfully by antidepressant medications or psychotherapy (talk therapy) in 65 percent of cases. Treatment response increases to more than 80 percent when medication and psychotherapy are combined.
• Panic disorder is a major reason for visits to hospital emergency rooms and physician's offices. Yet 70 - 90 percent of the time, medications and behavior therapy can treat this brain disorder.
• By comparison, the overall success rate of some commonly used treatments for heart disease is only 45 - 50 percent.

Chairman Smith, members of the committee - I submit to you that the brain disorders covered by HB 33 are as essential and basic as any health care can be. These disorders must be insured as basic health-care insurance. Our bodies are simply the shell in which we live. The most important purpose of that shell is to provide nourishment, mobility, and protection for our brain. The brain's function is to provide the substrate in which our mind can function. And our mind provides the essence of where we live. It makes no sense to provide basic health care for our brain through insurance for problems of movement, but not insure that very same brain, disrupted in the very same locations, for problems of perception and thought.

We are here to advocate for the acknowledgement of what is already widely established. The treatment of mental illnesses is an essential component of basic health care. Only lack of knowledge has allowed the history of stigma and myth to perpetuate this discrimination. It is time to update the insurance benefits in the state of Ohio to match our current knowledge. Thirty-five states, the Ohio State Employees' Plan, and the Federal government have all shown this to be the right choice. Don't leave our citizens stranded by limited access, or foreshortened benefits to the essential treatment that can restore their basic health. I urge each of you to support Representative Olman's HB 33.

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