Monday, March 19, 2007

Kennedy vs Kennedy in pursuit of the ghost of Paul Wellstone

The NYT describes the competing versions of a mental health parity bill, the Paul Wellstone-inspired House bill sponsored by Kennedy Jr., and the surprisingly pro-business bill sponsored by Papa Kennedy in the Senate.

The American Psychiatric Association supports both bills, describing them as different approaches to the same goal. Mental Health America, an advocacy group for patients, also supports both bills. But Ralph J. Ibson, the chief lobbyist for Mental Health America, said, “The House bill has greater protections and is therefore a stronger bill.”

The House bill is named for Paul Wellstone, the senator from Minnesota who championed similar legislation before he died in a plane crash in 2002. Jeff Blodgett, executive director of Wellstone Action, a nonprofit group that is continuing the Democratic senator’s work, said, “The Senate bill is a step forward, but the House version is true to Paul Wellstone’s vision.”

On behalf of the senator’s sons, David and Mark Wellstone, Mr. Blodgett said, he asked the Senate sponsors not to put the Wellstone name on the Senate bill at this time.

One of the biggest differences between the House and Senate bills is that the House version defines the “minimum scope of coverage.” Under the House bill, if a group health plan provides any mental health benefits, then it must cover the same wide range of mental illnesses and addiction disorders covered by the health plan with the largest enrollment of federal employees.

By contrast, the Senate bill does not specify what mental conditions or diagnoses must be covered.
Given that even Bush has endorsed the notion of mental health parity, at least in principle, I don't quite understand the necessity of the watered-down Senate Bill. Of course, industry doesn't like things that could possibly cost them money. Several policy memos I've read suggest that mental health parity probably wouldn't cost all that much anyway, and that concerns that the worried well (a term I despise, but will use in the context of this debate, in which it is so often cited) will flock to therapists for self-actualization probably don't make much sense.

Having seen at least one case in which a severely depressed patient ran out of psychiatry visits for the year during March, I'll be the first to admit that I'm going to be biased towards mental health parity. Since my salary will most likely depend on NIH instead of insurance companies, I can't say I have too much personal financial incentive in the matter.

But at some point, it seems like a lack of mental health parity comes down to simple discrimination against those with mental illness. We'll pay for your sprained ankle treatment, but not for your bipolar disorder. I'm pretty sure the situation isn't much more complicated than that, though I've seen plenty of people try to make it more complicated by distorting the realities of mental illness.

1 comment:

: Joseph j7uy5 said...

If you give them any wiggle room, they (insurance companies) will use it to their maximum advantage, and more.

A certain major company in Michigan, which is supposedly a nonprofit, pays bonuses to auditors who go through charts and find reasons to deny claims.

I have seen cases in which people with OCD had their claims denied, because it was not a "covered diagnosis." I have seen a case where a TSH was not covered for a patient on lithium, because the diagnosis was not on a list of conditions for which TSH was considered necessary. And so forth. So yes, you do have to spell it out in agonizing detail.