Cynical Synapse

Fri, 03 Oct 2008

The Bailout Bill and Mental Health

Filed under: Civil liberties, Economy, Medicine, Mental health, Politics, Take action — cynicalsynapse @ 12:50 am

First, if you haven’t urged your representatives to vote no on the bailout bill, you must be a friend of rich folk, or one yourself. But then, you’re probably not reading my blog. I’m happy to say most of Michigan’s representatives voted no on Monday (unfortunately, not mine). And the senators split on the Senate version. I hope the representatives stick to their ground tomorrow and, maybe, mine gets the message as well. Is it possible Congress actually represents us?

So, what’s the bailout got to do with mental health? Besides the anguish its costing everyone, actually, quite a bit. Ross Kaminsky has an interesting post on tax earmarks, pork, and other bailout bill horrors. The so-called “sweeteners” Ross cites have more to do with special interests than average folk. According to Ross, the bill also advances an environmentalist agenda, with the biggest issue being the alternative energy benefits which reduce incentive for developing a more comprehensive, bi-partisan energy bill. That may be, but it’s part of why one of my senators voted no.

Ross’ article cites two previously separate Senate bills that have been inserted into the bailout bill. I agree with the viewpoint neither of these belongs in the bailout plan. I have long thought it is a chickenshit, cowardly way of doing business for senators and representatives to attach amendments to bills—any bills—to further personal agendas or special interests. An highway bill should be highway stuff. Period. No extra stuff for extra votes or just to sneak it by.

I don’t know anything about the rural schools program, but mental health insurance parity I can speak to. First, it’s important to realize what’s tucked into the bailout bill is actually intended to be the resolution of details for the compromise bill already passed by both houses. So, it’s not as sneaky or insidious as some may imply.

Some talk about the cost of mental health parity. Let’s consider this. According to “the National Co-morbidity Survey-Replication (NCS-R) (Kessler et al., 2005), conducted in 2001 to 2003, the lifetime prevalence of any mood disorder among persons aged 18 years and older was nearly 21 percent.” Compare that rate to a rate of 0.11% for kidney dialysis. Nobody questions the need for dialysis, but which is really the bigger health problem? And oh, by the way, Chilcot et al (2008), indicated 20-30% depression rates for dialysis patients compared to an estimated 16% rate in the general population. From this, mental health issues are not necessarily separate from physical health issues. Often, state of mind has an effect on recuperation and recovery. Does it make sense to patch the wound and ignore the suffering?

My wife of 20+ years suffered from bi-polar (manic-depressive) disorder. She didn’t ask for this and it wasn’t the result of bad lifestyle choices. But insurance had lower lifetime limits of coverages, higher deductables, and reduced reimbursement rates. To this day, I don’t understand why they’d pay 80% for inpatient care (at say $500 per day) but only 50% for outpatient care (certainly not more than $150 per visit). Why does dental coverage often cover 100% of cleaning and exams?f

It seems to me better preventive care would avoid inpatient hospitalizations. Mental health parity, then, should actually result in lower costs to insurance by shifting the emphasis of care to outpatient, preventive care instead of reactive inpatient care. Keeping the mentally ill from decompensating enables them to be productive members of society and lowers treatment costs. Just like fluoride and teeth cleanings reduces the number of cavities and lowers overall dental healthcare costs.

Do you think there would be an outcry if 280,000 people had their dialysis treatments restricted to, say, 50 lifetime visits? Why should 64.1 million have restrictions on mental healthcare? That’s the magnitude of the problem! And, considering the current financial situation, expect this to grow. Think about the impact on families, too. Every time my wife was hospitalized, I had to arrange spur-of-the moment childcare and the kids were deprived of their mom on an average 2+ weeks for each incident. Some years were hospitalization-free, but some years saw 3 or 4 occurrences.

In his article, Ross cites a Congressional Budget Office report in support of the “costs” of mental health parity. There are statistics out there that will support any position you want to take. I’ll bet someone can give you a statistic to show the economy’s way ahead of where it’s ever been. The reality is mental health issues are a real detriment to our national power and they deserve equitable care and concern as provided for physical disabilities.

Nonetheless, mental health parity, as important as it might be, doesn’t trump corporate welfare. The bailout bill is still wrong and needs to be defeated. It’s not too late. Email or call your Congressman.


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