Copyright 1999 Plain Dealer Publishing Co.
The
Plain Dealer
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June 16, 1999 Wednesday, FINAL / ALL
SECTION: EDITORIALS & FORUM; Pg. 9B
LENGTH: 663 words
HEADLINE:
THE WRONG PATH FOR MENTAL HEALTH CARE
BYLINE: By Mark
Schiller
DATELINE: SAN FRANCISCO
BODY:
Last week's White House Conference on
Mental Health, led by Tipper Gore, promoted mental
health parity - the idea that insurers should be made to provide
coverage for mental health problems just as
they do for other illnesses.
The proposal has strong congressional
support, and President Bill Clinton recently extended mental health
coverage to federal employees. It also has long been a primary goal of
patient advocacy groups and professional associations in the field. Every day I
see heart-wrenching cases of people confronting debilitating mental disorders
and addiction problems, and I understand the desire to just do something -
anything. It is hard to resist these emotional appeals for mental health parity.
Such legislation also might lead to a business boom for me and my colleagues.
Despite this, it's a bad idea.
Nobody denies that mandated
mental health coverage would increase the cost of insurance.
Estimates range from 2.5 percent to 8.7 percent in the first year. Although
advocates believe that the lower range of these estimates would be
inconsequential, when added to the annual increases in premiums of 8 percent or
more that have become the norm, the burden would be far from negligible.
There would be long-range cost increases as well. New mental-health
centers and clinics would crop up to capitalize on the available insurance
money, and they would heavily promote their services. This trend already has
been seen with private psychiatric hospitals and substance-abuse centers, with
sometimes dubious results.
The proliferation of services would be fueled
by the fact that mental illnesses are difficult to diagnose. Such diagnoses are
still based upon subjective criteria and cannot be substantiated by objective
testing.
Even restricting the equal-coverage provision to severe mental
disorders, as a bill sponsored by Sens. Pete Domenici and Paul Wellstone would
do, would not solve such problems. Serious disorders like severe depression are
still so arbitrary and based on patient self-reporting that a lax practitioner,
especially one with a financial motive, can diagnose a disorder in just about
anybody who is merely unhappy. Indeed, few psychiatrists can honestly deny
having seen diagnoses "fudged" to obtain coverage or financing.
The cost increases brought about by mental health
parity would throw even more Americans into the ranks of the uninsured, which no
doubt would be the subject of a future White House conference. Higher costs
would force many businesses, particularly smaller ones, to drop all medical
coverage, and individuals might not be able to afford higher premiums.
There might be another unintended consequence as well: Current proposals
mandate parity of coverage only if policies already include
some mental health benefits. That would certainly lead many
businesses to drop all mental health coverage from their
policies.
The drive for mental health parity diverts us
from analyzing the real roots of our health-care problems. Our
system of employer-provided medical coverage is driven by the
tax deductibility of insurance for employers. That ties health care to jobs
rather than to people.
Employers often resort to one-size-fits-all
policies that do not reflect varying needs and preferences. And since workers
believe that someone else is paying for their medical expenses, they overuse
services.
We need a system in which individuals can purchase medical
insurance and services with tax-free dollars, allowing them to select the
coverage - including mental health coverage if
they desire - that best meets their needs. Expanding the availability of medical
savings accounts, which let people pay health expenses with pretax money, is a
step in the right direction.
Even more important are proposals for tax
credits for the purchase of insurance and medical services. True
health-care reform - including coverage for
mental health - should start with the individual, not a
national mandate.
LOAD-DATE: June 24, 1999
