Mental Health Insurance

The House recently passed a bill requiring insurance companies to provide mental health insurance parity, banning them from limiting mental health coverage. The insurance industry is up-in-arms and the mind-body debate continues raging:

Sarah Kershaw of the New York Times reports:

In the United States over the last five years, research studies examining the link between physical brain abnormalities and disorders like severe depression and schizophrenia have begun to make a strong case that the disorders are not scary tales of minds gone mad but manifestations of actual, and often fatal, problems in brain circuitry. These disorders affect behavior and mood, and they look different from Parkinson’s disease or multiple sclerosis in brain imaging. Still, a growing number of studies — and many more are under way — are making the biological connection, redefining the concept of mental illness as brain illness.

However…

Critics of parity say that anything that would not turn up in an autopsy, as in depression or agoraphobia, cannot be equated with physical illness, either in the pages of a medical text or on an insurance claim. These critics also say that because the mental abnormality research is so new, it should still be considered theory rather than an established basis for equal payment and treatment. “Schizophrenia and depression refer to behavior, not to cellular abnormalities,” said Jeffrey A. Schaler, a psychologist and an assistant professor of justice, law and society at American University in Washington. “So what constitutes medicine? Is it what anybody says is medicine? Is it acupuncture? Is it homeopathy?”

The bill, if passed, will be a 3.8billion dollar tax burden and mean a substantial (but unpredictable) raise in insurance premiums. Insurance companies argue that they shouldn’t be expected to pay for diseases that you can’t scientifically test for. Bush says he’ll veto the bill if it comes before him as the house passed it.

The “bare minimum” coverage that we currently require insurance companies to offer isn’t terribly inclusive. The House is attempting to considerably raise the bar. If the House really represents the will of the American people then I wonder why we’re on board. Is it that we really think mental disorders (or at least some mental disorders) should be treated like diseases or is it that we’re simply on the universal, more inclusive health care bandwagon?

I certainly hope it is the former. People who think schizophrenia is solely behavioral like Mr. Schaler (above) must not have ever visited a mental ward. Some mental illnesses are indubitably biological. It’s high time we formally recognized the body’s affect on the mind.

I do, however, hear the opposition’s point. We’re a long way from completely unifying the two. For the time being there’s a fine line between mental diseases (biologically rooted) and mental disorders (societally or behaviorally rooted). It isn’t outrageous to suggest that the psychiatric community should differentiate between the two before we force our broken insurance system to standardly cover all mental health. Some things, like most phobias for instance, you can live with. Other things, like schizophrenia or bipolar disorder, you cannot.

I think the bill is a step in the right direction, just not the right step. What do you think? Leave a comment.

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1 Response to “Mental Health Insurance”


  1. 1 theneurotic April 1, 2008 at 10:21 pm

    I apologize for the member-only NYT link. I don’t know why I could access it wherever I was when I first posted (I’m not a member).


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