How could we be so heartless?

I believe the NCPA is the only organization that has held a Congressional briefing challenging the idea of mental health parity. We may also be the only organization that has produced (not one, but three) publications opposing the idea.

As both houses of Congress stand poised to legislate, a bipartisan effort is being led by Senators Ted Kennedy (D-MA) and Pete Domenici (R-NM) and backed by the mental health industry, one of the strongest lobbies found anywhere.  Employer and insurance groups have caved.  President Bush is also on board.  So increasingly we are alone, as the only ones with any apparent pity for the poor souls this grand coalition is out to "help."

Here's the issue: Health insurers would not be required to cover mental health at all.  But if they did, they would have to apply the same deductibles and co-payments that apply to other services. To The New York Times, the law will be a "boon to the millions of Americans who suffer" from addiction, depression and even "stress."  Yet anyone who has taken economics 101 will recall that raising the cost of something usually means fewer people will acquire it.

Here's the question:  Would you want to pay higher premiums for an insurance plan that had the same deductible and co-payment for every procedure?  Need time to think about that?  Then try this: 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.

One way to keep insurance costs down is through incentives. 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.  Unlike fixing a broken leg, these are precisely the conditions that make patient cost sharing highly desirable.

If I haven't convinced you so far, consider this National Bureau of Economic Research study finding: 38 percent of all mental health patients - representing 28 percent of all treatment visits - are people who do not have any mental health disorder.

No matter how bad the new law is, the proponents wish it were worse - and they won't be satisfied.  If the history of other mandates is a guide, the advocates will be back for another round in the not too distant future.

John C. Goodman is President of the National Center for Policy Analysis.

http://www.ncpa.org/pub/ba/ba410/
http://www.ncpa.org/pub/ba/ba411/
http://www.ncpa.org/pub/ba/ba412/