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?
