My first BooMan Tribune diary (crossposted from Daily Kos)…
A study published March 30 in the New England Journal of Medicine by Howard Goldman, Richard Frank and colleagues finds strong evidence that improving mental health benefits does not substantially increase the cost of health insurance. The cost issue has been the main roadblock in permanently extending and strengthening the 1996 Domenici-Wellstone Mental Health Parity Act.
Why should you care about mental health parity? Three main reasons: 1) someday, you or someone you love could suffer from mental illness; 2) mental illness is vastly under-treated; 3) parity is a basic issue of fairness and justice.
More below the fold:
According to the American Psychiatric Association, 1 in 10 Americans suffer disability from a mental health disorder in any given year.
Right now, estimates are that 15 to 18% of Americans, including nearly 10 million children, suffer from a diagnosable mental disorder. And because the mind also affects the body, 50 to 70% of visits to primary care physicians are for medical complaints that stem from psychological factors.
According to a 2000 study by David Mechanic and Donna McAlpine, “in a 12-month period almost three-fifths of persons with severe mental illness did not receive specialty mental health care.” Lack of insurance is a serious barrier to care. But even those with health insurance face huge financial obstacles. According to the Substance Abuse and Mental Health Services Administration report on Mental Health in the United States, “more than half the expenditures required for persons in the community with severe mental illness are usually not covered by conventional health insurance (Hollingsworth & Sweeney, 1997).”
The conservative Heritage Foundation has argued against parity because it would “increase costs while limiting consumer choice and competition.” In other words, they think that economics justifies discrimination against people with mental illness. The whole “limiting choice and competition” argument is wholly unsupported by research and is nothing but “code-word” language to key-up their conservative base. The cost issue, at least at face value, may have some validity – and definitive studies were lacking.
Cost concerns were behind a provision inserted into the Mental Health Parity Act exempting employers if they expected (using who knows what methodology) costs to increase by more than 1%. This exception basically nullified the legislation.
The article published in the March 30, 2006 NEJM shows that when the Federal Employee Health Benefits Program adopted true mental health parity, overall program costs did not substantially increase relative to other similar commercial plans that did not adopt parity. According to an article in the March 30 Baltimore Sun:
With insurers picking up more of the costs that patients had paid, premiums might increase a little, but probably less than half of 1 percent, estimated Richard Frank, a health economist from Harvard who was a co-author of the study.
This number is important, because it could mean that the cost exemption for parity in the current Mental Health Parity Act is null and void.
So, the business case against parity has now been cast into doubt. To the contrary, when you consider the economic losses from sick days, decreased productivity and other health issues caused by mental illness, there is a strong business case for quality mental health services.
This issue will come up for debate again soon, as the existing flawed (but perhaps now less so) Mental Health Parity Act only runs through December 31, 2006 and will need to be extended. The law should also be revised to reflect our new knowledge that the costs of mental health parity should not prevent insurers from doing the right thing. It’s good for our health, it’s good for business, and it’s the right thing to do.
