In Case You Thought That Everyone Loved Mental Health Parity

It is really hard to blog about Children's Mental Health with the election closing to a climax- I find myself drifting over to 538.com, to see how the election goes.  I have avoided such comments on the blog, but I do live in New England, and my preferences are probably predictable.  I will try to maintain focus and I look forward to Wednesday, when we can get on with the work.

For now, however, I have to share a story to remind how hard this work is.  I just found this piece in the Baltimore Sun, which seems to be generating some buzz in web.  

'Parity' through back door:   Controversial and costly mental health coverage mandate is slipped through on back of bailout bill

By Richard E. Vatz and Jeffrey A. Schaler

Psychiatric self-interest groups have tried for years to force insurance companies to cover the treatment of mental illness and addiction. Treating depression as well as disturbing and sometimes simple problems in living on the same level as cancer, heart disease and diabetes is the essence of what has come to be known as "parity."
Now, through political legerdemain, this government-mandated coverage has just become law as an amendment attached to the Emergency Economic Stabilization Act of 2008.
The parity amendment requires that mental health and substance use disorder benefits be "no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered" by an insurance group health plan or coverage (if said plan covers mental illness). That has a reasonable sound to it. Unfortunately, though, this legislation, unless reversed - or at least modified to apply only to severe disorders - is likely to open up a Pandora's box for the American health care system.  Click for rest of article

Comments, anyone?  I have to say that when I first saw this, I was thinking to myself, I really wondered if they were talking about the same bill that I worked on in DC.  I saw the bill as being supported by parents and families of folks with mental illness, who I guess are a "self-interest group"- but the language makes it sound like that is a bad thing.  I was puzzled by this, until I realized that Dr. Vatz has a PhD in "rhetoric" and is skilled at the use of language in a way that I hadn't perceived in the past.  The second sentence further shows his skill at reframing the argument:  he conflates "depression" with "problems in living" and then accuses parity of equating those with "cancer, heart disease and diabetes".  I would argue that depression is associated with a similar degree of morbidity (days of work lost) and mortality (suicide kills more thirty year olds than cancer),  but it was the conflation that troubled me:  "problems in living" seems to be his code work for "overdiagnosis of psychiatric disorders" such as adjustment disorder (cited later in the article), that he feels do not warrant treatment.  To me, of course, the proper comparison for adjustment disorder in the physical realm would be fatigue or headache- a relatively minor problem that frequently appears on my primary care docket and is covered by medical insurance as a medical problem.  Why shouldn't health insurance cover that too?

The rest of the article follows the pattern set up in the first two sentences, setting up a straw man, and following subtly inaccurate patterns of logic to the erroneous conclusion that the mental health parity bill was "snuck through" (not that it had already passed both houses and was snagged on a technicality in the Senate), and that "they" had somehow stuck it to us again.  It is interesting, however, to see how even a "no-brainer" law can evoke powerful opposition.

OK, back to my electoral obsession now.