Lost amid the hubbub over money Congress quietly opened up a real Pandora's Box Tuesday, agreeing to give mental health parity with physical health in health insurance. (Picture from Sean and Jenna Daly.)
HR 6983, currently named for the late Paul Wellstone and Republican Pete Domenici, still needs a conference, final passage, and the President's signature.
But advocates on both sides of the aisle think they will get it done.
My personal view is this is a great day. I agree with those who say mental illness should not be seen as a character flaw.
But goodwill does not solve problems by itself, and there are problems on both sides in this bill.
- Employers can avoid the bill's requirement by simply not offering any mental health coverage.
- Treatment for mental illness is at least a century behind that for physical illness. We don't know what works, we can't predict outcomes.
I think we all look at this through our own prism, but I have to compare what I've done for my hypertension with what I've done for my ADHD.
Drug therapy, regular check-ups, and lifestyle changes have helped the hypertension. The cost, if my compliance remains high, should be fairly predictable and, for most of my life, reasonable.
Not true with ADHD. While drugs have been offered, the best treatment in my case was a specific type of talk therapy, a "coaching" technique that not many people practice. (Also, part of the cure was seeing that this is not a disability, but a difference that can be a positive boon.)
Finding that treatment took years, during which I spent tens of thousands of dollars with doctors who gave me no help. Discussions with other patients, and those with other problems, indicate this can be typical.
Some drugs help with some mental illnesses, but nothing is certain. Talk therapies, like drug treatment, can deliver cures, but the success rate is lower than for surgery, and heavily dependent on patient compliance.
Until you decide you want to get better it is hard to recover from any mental condition. You might argue this is also true for obesity and the diseases which result from it, but not to the same degree.
Mental health costs are simply not as easy to estimate as costs for covering physical health.
So how can you insure it?