Around 1990, just after having entered the field, changes to how insurance companies provided mental health care coverage was changed. When I first started, it was not unusual for a patient to stay inpatient for weeks or even months while an evaluation was done, a treatment plan formed and implemented. Once the patient was stable, he or she was discharged.
The changes made coverage work more like medical health care coverage. Insurance companies were allowed to put limitations on inpatient stays based on the diagnosis, i.e. if the patient had a heart condition, the insurance company would allow X amount of days of inpatient care. If more time was needed, the hospital had to try to get the insurance company to approve it. If they didn't, more often than not, the patient is suddenly cured and discharged before the coverage runs out.
Likewise, insurance companies did the same thing for mental health patients. If the patient was schizophrenic, they might get a week. Depression was good for three or four days. This was, of course, impossible to do most times, and created very unreliable funding streams for the hospital. This caused havoc for the hospitals and many private hospitals closed down, dumping the burden on the ones that remained, usually publicly operated ones.
Obviously, because of my education and my work experience, I continue to be interested in things that affect mental health services.
One of these things was the passage of the Wellstone Mental Health and Addiction Equity Act, which was designed to bring parity to coverage of mental health issues. At the time that the act was passed and signed by President George W. Bush, there were many right wingers decrying the expense, even though the cost increase was going to be less than one percent.
Now that the act is about to go into effect, there have been some fallout. One of the big stories was that Woodman's Food Market was going to stop providing mental health care coverage altogether, claiming that it would be too expensive.
Patrick McIlheran, right wing shill at the Milwaukee Journal Sentinel, predictably comes out in defense of Woodman's indefensible position. He cites two basic reasons in trying to justify Woodman's actions.
The first reason is the echo of Woodman's complaint that it would be just too expensive. But the article that McIlheran cites to back his position also includes this (emphasis mine):
Greer points out that in other states that have already passed similar state parity laws the price of insurance coverage has only gone up less than one percent. He also says that stinting on care up front will lead to higher costs down the road and is one of the reasons health care costs are exploding in this country.
When they have no mental health insurance benefits, he says, workers tend to put off medical care for their mental health issues. "They don’t take the preventative route, and they wait until a crisis happens and they end up in the emergency room," he says. "The costs end up being higher in that situation."
And while on the subject of costs, I would be remiss if I did not point out, just as I did when I first wrote about this almost two years ago, that the cost of untreated mental health issues are far, far greater than the cost of treating them.
There are reasons, health economist John Goodman noted during the debate, for covering different sorts of illnesses differently:
"Does it make sense to have the same deductibles and co-payments for chiropractic therapy as for setting a broken leg? Or from the mental health field, should the payment terms that cover bipolar disorder be the same as those that apply to marriage counseling (required coverage in some states)? Should pastoral counseling (also required in some places) be reimbursed the same way as coverage for schizophrenia? If you have any sense, the answers are: No, No, No and No."
"Patients should pay more of their bill when they exercise discretion and especially where patient discretion is appropriate. In mental health, this principle applies in spades because:
"1. the illness is often experienced subjectively,
"2. there are often no objective standards for diagnosis or treatment,
"3. doctors often exercise enormous discretion,
"4. patients also exercise a lot of discretion and
"5. patient cooperation is often crucial to any cure."
Well, this is absolutely nuttier than yesterday's fruit cake.As for the first point, all illnesses are subjective. The same disease can affect people in different ways, anywhere from having no ill effects to being totally devastating or even fatal.
Regarding the second point, this is utter rubbish and completely incorrect. There is the DSM-IV-TR which offers both the criteria for diagnoses and for treatment.
And as with the first point, points 3, 4 and 5 all also apply to any illness whether it be psychiatric or purely physical.
There are always stories of doctors, usually from HMOs, that are misdiagnosing medical conditions. Likewise, there are tons of stories of patients that don't follow doctor's orders, like the person with emphysema who continues to smoke, or the person with a heart condition that continues to drink alcohol and eat fatty foods. And I would dare say that many of us don't tell the doctor everything, of won't even go to the doctor until the problem is well advanced, out of denial and mortal fear.
When people like McIlheran and Goodman or companies like Woodman's try to use these flimsy excuses to prevent people from being able to access mental health service they might need, it is very hard to determine if they are dabbling in psychobabble or are simply exposing us to psychos babbling.
One thing I do know for sure. I won't be patronizing Woodman's Food Market while their wrong-headed policy is in place.
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