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The Right Prescription
The Troubling Psychology of Health Care
What about mental health services under universal care?
Among the more intriguing, and disturbing, questions swirling around the prospect of government-run universal health care is how the final version of the plan will deal with mental health services. While a senator, President Obama co-sponsored the Mental Health Parity Act of 2007. “Parity,” he has claimed, “means that we don’t allow group health plans to impose treatment or financial limitations on mental health benefits that are different from those applied to medical or surgical services.”
Historically, many insurance companies have limited their coverage of treatments for mental health conditions like chronic depression or bipolar disorder. You’d assume, given his track record, that any bill the President eventually signs would require the government to pick up the tab for institutionalizing and rehabilitating psychiatric patients for at least as long as the plan paid for hospitalizing and rehabilitating, for example, cancer patients.
But the principle of mental health parity also opens a large can of worms. For instance, Obama has stressed the crucial role of “prevention” in improving health care; not surprisingly, therefore, he’s been urged by health and fitness organizations nationwide to include funding for physical activities in his plan—to ward off the effects of childhood and adult obesity. But, in the spirit of mental health parity, since physical ailments ranging from hypertension and ulcers to acne and sexual impotence have psychological components, and since more severe mental ailments often flow from less severe ones, wouldn’t Obama’s commitment to prevention suggest that psychotherapeutic counseling should likewise be covered? Wouldn’t psychotherapy count as a preventative measure?
Indeed, the original July 14th draft of the health care reform bill produced by the House of Representatives explicitly stated: “The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for mental health counselor services for which payment may be made directly to the mental health counselor… under which such a counselor must agree to consult with a patient’s attending or primary care physician in accordance with such criteria.”
The trouble with that, however, is that there’s no scholarly consensus about what psychotherapy’s goals are, what its proper methodology consists of, or whether it works better than just ordinary social interaction. If Freudian psychoanalysis and Gestalt therapy are covered, does that mean that art therapy or dance therapy or primal scream therapy should also be covered?
Beyond these lie other dilemmas which future Secretaries of Health and Human Services will likely confront. If psychotherapy can reduce or prevent certain physical and mental illnesses, cannot the same be said of, say, meditation? What about aura cleansing? Crystal healing?
People regularly gripe about insurance companies because insurance companies occasionally say no — which is a major reason why Nancy Pelosi and company provided House Democrats with a memo before their August recess instructing them to paint insurance companies as villains in the health care debate. But insurance companies operate on a sustainable business model; their default position, therefore, is not to cover treatments without empirical evidence of their efficacy.
Will a government-run health care system, which prioritizes prevention and which is committed to the principle of mental health parity, say no to anything?
Will it bankrupt the nation if it doesn’t?
Letter to the Editor View all comments (33) | Leave a comment
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Kevin Frei| 9.3.09 @ 8:55AM
The perpetual Viking funeral: Just how many trillions of dollars is a tribute to Senator Kennedy worth?
The liberal obsession with passing the so-called health care reform bill entered a new phase with the passing of Senator Ted Kennedy. The new liberal clarion call to pass this bill has become: “Pass the bill as a fitting tribute to the life’s work of Senator Kennedy.” The idea of renaming the bill in Senator Kennedy’s honor harkens back to the passage of the civil rights legislation of the 1960’s following the tragic assassination of the Senator’s brother, President John F. Kennedy.
What liberals fail to understand is that this civil rights legislation is fundamentally unlike the so-called health care legislation. The civil rights laws used the power of the federal government to force the segregationist southern states (controlled by Democrats) to respect the civil rights of minority citizens. In the parlance of constitutional scholars, like our President, the civil rights legislation enforced the negative charter of rights (protection from governmental action) given to us in the Constitution and its Amendments on the fifty state governments.
This proposed health care bill’s passage into law would vastly expand the government’s power over our lives, crowd out necessary defense spending increases and fundamentally threaten the growth of the private sector.
Passage of such a health care bill and its inevitable expansions over time would give the federal government control of a huge slice of America’s economy, about 7% of the nation’s private sector. Currently, the private health care sector of our economy is a wealth generator for our nation. The passage and then prospective growth of federal control of this sector of our economy would transform that sector into a wealth consumer.
Under the “single payer system” the federal government would displace the private health care insurance companies (employing 10’s of thousands of people and destroying the equity of those companies for their investors). If such a bill passes, how many people will chose a career in the health care industry, just as the Baby Boomers begin to retire enmass?
Some may have not understood the reference to a Viking funeral. The Vikings were a pre-capitalist pagan civilization ruled by nobles, which used pillaging as means of living. The Vikings swept out of their poor Scandinavian homelands to pillage the richer more southern regions of feudal Europe. They would steal anything of value and leave a wake of destruction behind them. The Vikings had a unique method of honoring the passing of a king: the Viking funeral. The dead king was put into a Viking ship along with wealth: iron weapons, trophies, and even servants. The ship was set on fire and then set adrift. Of course all the wealth of the ship and its contents was destroyed forever. If such a bill passes it will threaten not only the fiscal integrity of the federal budget, but also the whole economy of the US.
tj| 9.3.09 @ 10:21AM
If such a bill passes it will threaten not only the fiscal integrity of the federal budget, but also the whole economy of the US.
I do believe that is what these IDIOTS have in mind....Czars, Racists, Communists, Illegal immigrants, Corrupto crats.
Tim| 9.3.09 @ 2:22PM
One sometimes gets the impression that the mere words 'Socialism' and 'Communism' draw towards them with magnetic force every fruit-juice drinker, nudist, sandal-wearer, sex-maniac, Quaker, 'Nature Cure' quack, pacifist, and feminist in England.
George Orwell, The Road to Wigan Pier (1937)
jr| 9.3.09 @ 5:11PM
I have a relative who has had several thousand dollars of mental health care. The most tangible benefits are comfort and willing to listen and prescription of drugs to alleviate anxiety. Cure? No. Likewise the same person has had numerous sessions with docs for breathing problems - coupled with the person's age and weight. This has had the same outcome. No cure. And perhaps there is no cure. That doc has never told the person to get the weight off and do breathing exercises. I have said it but since I'm not an M.D. my voice isn't heard. As in the article, there are no measures of medical outcomes for many problems but if docs got paid for success many might go bust. Case: Norwood (?) Canada with 22k population has a weekly drawing at the Mayor's office to see who gets to see the local doc. More explanation needed?
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Eugenics in Israel: Did Jews try to improve the human race too?
By Yotam Feldman
Tags: Psychiatry, Jewish People
In 1944, psychiatrist Kurt Levinstein gave a lecture at a Tel Aviv conference, where he advocated preventing people with various mental and neurological disorders - such as alcoholism, manic depression and epilepsy - from bringing children into the world.
The means he proposed - prohibition of marriage, contraception, abortion and sterilization - were acceptable in Europe and the United States in the first decades of the 20th century, within the framework of eugenics: the science aimed at improving the human race.
In the 1930s, the Nazis used these same methods in the early stages of their plan to strengthen the Aryan race. Levinstein was aware, of course, of the dubious political connotations implicit in his recommendations, but believed the solid and salutary principles of eugenics could be isolated from their use by the Nazis.
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Recent research by historian Rakefet Zalashik on the history of psychiatry in Palestine during the Mandate period and following the founding of the state shows that Levinstein was far from a lone voice. Indeed, she claims in her 2008 book, "Ad Nefesh: Refugees, Immigrants, Newcomers and the Israeli Psychiatric Establishment" (Hakibbutz Hameuchad; in Hebrew), that the eugenics-based concept of "social engineering" was part of the psychiatric mainstream here from the 1930s through the 1950s.
Jewish psychiatrists in Israel were not the only ones who tried to distinguish between the science of eugenics, which they held to be useful, and the Nazis' application of it. What set the local experts apart was that they actually studied the foundations of the theory in Germany before immigrating to Palestine, directly from the scientists who supported using eugenics to forcibly sterilize mentally ill and physically disabled Germans - and subsequently to justify their murder. Within a few years, the German scientists were using the same justification for killing Jews.
Curtis| 9.5.09 @ 10:42AM
Psychological and Psychiatric treatment covered and encouraged under Obamacare? Now THIS has major ramifications.
So you go to a doctor who says your BP is high, and you need to chill out, and sends you to a shrink. The shrink says your stressed, and depressed, and tells you to play with your inner child and take a couple prozacs.
The problem is that now you are officially diagnosed with a psychological issue, and that tag lasts pretty much forever. How can you measure when you are no longer depressed? How will you know if that's because your 'better' or because you are on meds?
In meanwhile, you can't get a security clearance job. No working at a nuclear power plant for you. That diagnosis is going to slam alot of employment opportunities, who wants to hire a nut?
You may find your 2nd Amendment rights in jeopardy when comes time to sign your BATFE forms to take delivery of that new plinking rifle.
Your spouse now has another good bullet when it comes time to pillage you in divorce court, "He's nuts I tell ya! Thats why I should get the kids and the camaro!"
The military is having some major issues with kids coming in who had prescriptions for ADD and ADHD and obsessive compulsive disorder and all other "My kids being a kid" disorders that were popular throught out the 90s. The military can't give these kids security clearances or flight status, they can't let them work on the hightech gadgets like stealth planes or helicopters, so they wind up with either kitchen utensils or idiot sticks, working the suck jobs. Right next to the kids who smoked pot and the kids who are struggling not to gain weight.
In short, a psychiatric diagnosis of a minor issue, can have major consequences down the road. In the super nanny state we're moving towards, those consequences are only going to get bigger. Can't let the nut jobs run free, they might hurt some one. In the data collecting society we live in, those consequences will never die. The data will be put on the network, for instant access by potential employers, law enforcement, government bureaucrats, and bored teenage hackers. Your past will always follow you, and the judgment for those minor details will grow larger and larger.
Kurt| 9.6.09 @ 5:35PM
In addition to what Curtis wrote-this is why 19 billion dollars of stimulus money is going for upgrades to health care communications upgrades. Soon it will be, no, your not covered under anything but a white sheet.
prof. R. Randall| 11.16.09 @ 3:39AM
In a national study of 681 chronically depressed patients, psychotherapy combined with the antidepressant Serzone improved mood in 85 percent of patients after only three months of treatment. A national research team, which included University of Texas Southwestern Medical Center at Dallas researchers, reported their findings in New England Journal of Medicine.
Dr. John Rush, vice chairman for research in psychiatry, and Dr. Madhukar Trivedi, associate professor of psychiatry and principal investigator at the Dallas site, concluded that this combination therapy was overwhelmingly more effective than either medication or psychotherapy alone for treating chronic depression.
Trivedi said the 85 percent response rate is the highest for a three-month period for any peer-reviewed depression study. It is the largest study ever undertaken, evaluating the three methods for treating chronic depression.
"These findings on the dual-treatment approach for the treatment of chronic depression are incredibly exciting," Trivedi said. "The large differences in response rates after only three months of treatment is truly astonishing. This approach has proven the kind of treatment we should be using with our chronically depressed patients."
With 14 million Americans suffering from chronic depression, Trivedi hopes that insurance companies are taking note. "We expect that our findings will help with our battles about paying for the most effective treatments for depression," he said. Depression costs the U.S. economy $53 billion each year.
Psychiatric Disorders in America
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