Bashing This Coverage Is Just Crazy
Bashing Washington, D.C., is sort of a national sport, so fairness demands that we stop and give thanks when Our Gang manages to do something right. And the Senate did last month when it unanimously passed legislation requiring mental illness to be treated the same as physical illness under health insurance coverage.
A great squawking promptly rose from the U.S. Chamber of Commerce and other business representatives. Much outdated misinformation was trotted out concerning the potential cost, and the dread word “mandate” was invoked.
One of the interesting things about these “yes-it-will/no-it-won’t” arguments we manage to have when something new is proposed is that both sides are given to overlooking existing evidence. You may recall that we had a furious debate over national health insurance two years ago without ever glancing north, where Canada sits with its usual modesty and an excellent single-payer system.
This time, the concept of parity for mental illness under health insurance has once more brought on wildly overblown cost estimates, with no reference to the fact that five states and several large corporations (Honeywell and IBM) already provide parity for mental illness. And none of them is going broke.
Xerox, Conoco, Alcan Aluminum, etc., are not noticeably charitable institutions, but what they have found is that their overall costs go down when treatment for mental illness is insured under standards that are effective and appropriate. Managed-health-care systems uniformly report shorter hospital stays and more effective treatments for mental illness. Because so many new and effective treatments have been developed in the last 10 years, and even the last two years, only the most recent data are now relevant.
Proponents of parity insist that there is no difference between a disorder of the brain and a disorder of the kidney. But there is a difference, and the difference is in public attitudes. Shame, fear and guilt are still attached to mental illness. Those with clinical depression are still advised to “pull up their socks” or to read “The Power of Positive Thinking.” Many still think of psychiatry as the self-indulgent pastime of wealthy weaklings.
But researchers are making the most astonishing progress in treatment of depression, bipolar disorder, schizophrenia and obsessive-compulsive disorders. Indeed, the success rate in treating these diseases is far higher than, say, heart disease, but insurance companies still discriminate by demanding higher co-payments and providing less coverage. The National Institute of Mental Health estimates that most treatments have a 60 percent to 80 percent success rate.
Our society has a hard time getting a grip on the notion that neither shame nor blame should be attached to mental illness. I believe that shame will haunt us in the near future when we realize how many people we have executed were actually sick.
Tipper Gore, a longtime advocate for the mentally ill, pointed out in a Washington Post piece that the parity proposal has come up at a time when health care in this country is changing massively and rapidly. The Clinton proposal for managed health care that set off such an uproar two years ago is already fact. Tens of millions of people are now under managed health care. Hillary Rodham Clinton’s proposals now seem like a prediction. Health-care costs are pushing people into health maintenance organizations, and insurance companies rather than doctors increasingly decide what kind and level of care is appropriate. Personally, I think that’s a worse result than the Clinton proposals, but there it is.
People who were dead-set against “gummint interference” in the health-care system are now counting on state and federal government to protect their interests against insurers and HMOs. It is a proper role for government to end discrimination against those who are mentally ill.
Many years ago, a beautiful, much-loved daughter of wonderful parents was sexually abused over a period of years by a neighbor, one of several children in the neighborhood to so suffer. The criminal told the children that he would kill their parents if they told on him. I am happy to report that the man is now serving several concurrent life sentences. But the young woman now has fullblown schizophrenia. Had she been crippled in a car accident as a child, her father’s medical insurance would have paid for all her treatment. What possible excuse is there for treating her illness differently?
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