don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

A cartoon in the May 4, 2002 edition of the St. Petersburg Times captures my sentiments about President Bush's decision to endorse calls for adding mandatory mental health benefits to health insurance policies. The cartoon depicted a staff person in the Oval Office advising the president as follows: "Even though we can't afford the entitlements we currently have and it would severely exacerbate rising health care costs, we should advocate mental health coverage." Another advisor remarks, "What are you, nuts?"

The president now seeks legislation for mental health coverage "to eliminate disparities between coverage of patients with mental and physical ailments," adding: "Our health insurance system must treat mental illness like any other disease.'' It must? The president added: "But, it must not significantly run up the cost of health care." So, if I understand our leader, it is OK to "run up costs, but not significantly."

Actually, follow up discussions by representatives of the press with the White House advisors revealed that the president favors coverage "only for the most serious mental illnesses, defined as major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder." Well, I suppose THAT won't run up costs SIGNIFICANTLY!

In fact, the White House, via the office of press secretary Ari Fleischer, acknowledged one big problem in adding to the current crisis of unaffordable heath (medical) insurance. This occurred when Mr. Fleischer explained that the administration's goal was to achieve "maximum parity in insurance coverage without driving up costs so high that people lose insurance in the end.'' The US Chamber of Commerce and other business interests have repeatedly warned that employees have been losing health insurance benefits at a rapid rate in the last two years due to the 20 to 30 percent increases in health insurance costs WITHOUT the added costs of mental health coverage.

The president said, "Americans with mental illness deserve our understanding, and they deserve excellent care." Of course they and everyone afflicted with anything or nothing at all for that matter deserves "our understanding." I'm not sure what the president has in mind about "understanding", but I know one thing: understanding comes cheap. "Excellent care," on the other hand, can get expensive. I think the president and others who want to offer excellent care for mental health patients should honor us with a few specifics about how much that care, and the understanding that goes with it, is going to cost if the federal government mandates it. Who, in short, will pay for such understanding? I can already guess the identity of who will be invited to pay! Can you?

I don't want to pick on President Bush, given his need to focus on Evil Doers. Yet, by supporting a massive increase in already out-of-control health care costs, it seems the national ship is getting too close to rocky shoals for comfort! In addition, there is a bill in Congress that would require companies to offer complete parity in employee health insurance coverage for the customary medical and ALL mental health aberrations. This would apply to all terms that affect health insurance, including deductibles, co-insurance and duration of treatment provisions

To have a sensible, rational discussion of adding coverage for the diagnosis and treatment of mental health problems, we should begin with a sense for the extent of the problem. In 1999, a report issued by the office of the surgeon general noted that more than 50 million Americans -- roughly one in five -- suffer from mental illness annually! The cost of "understanding" a problem of this extent could get really expensive! Of course, NOT diagnosing and effectively treating people with mental health issues is expensive, too. One report from the National Institute of Mental Health (NIMH) estimated that the untreated mental illness costs (criminal justice and social welfare costs, for instance) for even half this population are at least $300 billion annually.

There is no question but that the need is there. However, what we also require before consenting to yet another add-on program to one already under fiscal siege is a clear awareness of how it will be financed, by whom and at what cost.

Politicians much prefer to propose benefits than to discuss payment methods for such goodies. Yet, in all circumstances, the source and amounts of such payments ARE important. This would be true in the case of mental health benefits, even if there were no crisis in paying for existing benefits. To offer goodies without revealing how much added burden will be placed on taxpayers is simply irresponsible. Calling such political behavior "irresponsible" is being kind -- it's worse than that but I'm in a charitable mood at the moment.

It would be good if everyone could have a nice car, a big house, fine clothes, eat in the best restaurants and send his/her kids to the best schools, for starters. However, resources ARE finite and life IS unfair.

All the same, don't let any of this reality information dissuade you or distract you from always looking on the bright side of life, anyway!

(Note: This essay will be filed in the archives in the MENTAL DOMAIN under the skill area of mental health. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

 Send e-mail to Don Ardell