Copyright 1999 Times Publishing Company
St.
Petersburg Times
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June 23, 1999, Wednesday, 0 South Pinellas
Edition
SECTION: EDITORIAL; EDITORIALS; Pg. 10A
LENGTH: 638 words
HEADLINE:
Cautious coverage
BODY:
Congress must act
carefully to produce a plan that protects everyone while providing
coverage for the millions of Americans who suffer from
mental illnesses.
Should health
insurers be required to cover mental illnesses the same way
they do physical ailments?
It's not hard to understand why many people -
Tipper Gore, Rosalynn Carter and President Clinton among them - say yes. Mental
illness is a disorder of the brain, not a character flaw. It strikes one in five
Americans and exacts an enormous toll, emotionally and financially, on families.
It costs the nation billions of dollars every year in lost work and
productivity. Yet, underlying those simple truths are complexities that should
not get lost in the "parity" debate now gaining steam in Washington. Like
physical maladies, not all mental illnesses are equal. Congress should tread
carefully so as to ensure sufficient coverage for well-recognized mental
illnesses without throwing the door open to unfounded or unmanageable claims.
While few question the wisdom of parity for the most severe mental
illnesses, including schizophrenia, bipolar disorders and major depression, both
President Clinton's recent executive order and the parity proposals circulating
on Capitol Hill are written too broadly. Clinton extended parity to federal
employees - and rolled substance-abuse treatment into the mandate - without much
effort to define or limit the mental illnesses that will be covered. And though
the bipartisan proposal by Sens. Pete Domenici, R-N.M., and Paul Wellstone,
D-Minn., would allow insurers to charge higher co-payments for less serious
mental illnesses, it, too, fails to address legitimate concerns over the true
costs of such dictates.
In calculating those costs, lawmakers need to
consider that certain mental illnesses can be more difficult to identify, treat
and contain than others. Depression is only one example. Doctors say there are
more than six different categories of depression, each with its own
sometimes-subtle symptoms and treatment, and that number may grow to 10 within
the decade. Patients often have to consult with several doctors just to get the
right diagnosis. Once the appropriate diagnosis is made, eight in 10 patients
will ultimately respond, but it may take years of trial-and-error treatments -
and a regimen of medications, counseling or other forms of therapy - to see
results. Costs may be driven up further by doctors or other medical
practitioners seeking to reap the benefit of new insurance plans through
diagnosis-tailoring, if not outright fraud.
How will the system absorb
the new pressures? The Domenici-Wellstone proposal requires parity only in
policies already offering some mental-health benefits. If crafted too broadly,
the mandates could prompt insurers and employers to reduce
physical-health benefits - or withdraw mental-health
coverage altogether. The well-intended effort to extend
coverage could end up constricting it.
There is also
the issue of bracket-creep. As much as our understanding of biologically based
mental illness has grown over the years - and will continue to do so with good
efforts such as this month's first-ever White House Conference on Mental Health
- experts continue to disagree over how to label a host of addictions and other
maladies affecting emotion and behavior. Though mental illness can and often
does lead to substance-abuse, not all addictions derive from a mental
disability. Would all phobias have to be covered? What about sex addiction?
Voyeurism? Shyness?
As with health insurance for physical illnesses,
choices have to be made. Congress needs to find a way to extend coverage to the
millions of Americans suffering from serious mental illnesses, without opening
up a Pandora's box that could end up crippling the system for all.
LOAD-DATE: June 23, 1999
