An unfair reform bill

August 11, 1996|By Douglas J. Peddicord

SIDESTEPPING a months-long impasse by agreeing to allow a limited test of tax-exempt medical savings accounts, Congress recently passed the Kennedy-Kassebaum health insurance reform legislation, ensuring that most employees will be able to carry their health coverage from job to job, without losing protection because of pre-existing medical conditions. Eager for any progress on health care, President Clinton has promised to sign the measure. For the millions of Americans who change or lose jobs every year, that's good news.

Unfortunately, a provision directing insurers and managed care companies to cover mental health services under the same standards applied to the treatment of physical illnesses fell victim to concerns about its impact on the cost of insurance, and opponents' wildly exaggerated portrayal of exactly what it required. The amendment was was dropped from the final bill.

In April, proving that personal experience with an issue can make for strange political bedfellows indeed, Pete V. Domenici, a bedrock conservative from New Mexico, and Paul Wellstone, a firebrand liberal Democrat from Minnesota, joined together to co-sponsor the mental health parity provision. Specifically, their amendment stated that employer health plans and insurers "shall not impose treatment limitations or financial requirements on the coverage of mental health services if similar limitations or requirements are not imposed on coverage for services for other conditions."

Today, most health plans include at least some mental health coverage, but more than 90 percent apply much stricter limits on treating mental disorders than treating physical conditions.

A typical policy might allow 30 days of psychiatric hospitalization, require a 50 percent co-payment for outpatient services and set a lifetime spending limit of $50,000 for mental illness, while providing 120 or more hospital days annually, requiring only a 20 percent co-pay for outpatient care and capping lifetime spending at $1 million or more for the treatment of cancer or heart disease or spina bifida.

Domenici, whose daughter periodically suffers with schizophrenia, and Wellstone, whose boyhood was colored by the strains of crushing medical bills caused by an older brother's mental illness, are all too aware of the crises families face when mental disorders long outlast those arbitrary limits.

Opponents of the amendment offered a number of arguments. Mental illness is too hard to define, they said, and such legislation would result in precious health resources' being wasted on unnecessary treatments. Further, Domenici-Wellstone would mandate a mental health benefit, an example of the kind of government meddling in health care roundly rejected during the Clinton health plan debate.

Critics in the business community, meanwhile, strongly argued that expanded mental health coverage would cause health insurance premiums to rise significantly, and lead many employers to reduce or eliminate health benefits.

An overheated article in the Wall Street Journal perhaps best exemplified the argument that parity would cause health care costs to run amok. Psychiatrists and other mental health practitioners, the authors claimed, can diagnose almost anyone as having a mental disorder. Parity, they said, would mandate treatment even of those who were merely unhappy, and require coverage of Woody Allen's purported "33 years of continuous psychoanalysis" -- raising the presumably horrifying specter that some unsuspecting insurance company has for years been indiscriminately pouring money into the "black hole" of Woody's psyche.

In fact, like asthma or colitis or diabetes, mental disorders occur along a continuum of severity, with effects upon patients ranging from transient and relatively mild distress to profound and chronic impairment of day-to-day living. While National Institute of Mental Health surveys indicate that upward of one out of five Americans suffers with a diagnosable mental disorder in any given year, less than 3 percent have a severe condition like schizophrenia, bipolar disorder (manic-depression) or a disabling panic disorder. As with physical illnesses, a very small number of patients need intense and expensive treatments and account for most costs.

The least expensive forms of treatment for mental disorders -- psychotherapy, medication management or a combination of the two, delivered on an outpatient basis -- actually account for only about one-fifth of expenditures.

Studies indicate that approximately half of those who seek outpatient mental health care are seen for three sessions or less, and perhaps 10 percent use 24 sessions or more in a year. The policies of many managed care companies indicate that the excessive treatment of the mythical "worried well" does not represent a realistic threat to health care costs.

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