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Mental health bill is a dilemma
© St. Petersburg Times WASHINGTON -- Pity the poor HMO. After a decade of searing criticism, much of it justified, health maintenance organizations are beginning to deserve our sympathy. They are the latest victims of the widespread notion that Americans deserve first-class health care at cut-rate prices. HMOs, you will recall, were created to control soaring health care costs. The idea was that these organizations would control patient access to expensive procedures and, therefore, save money. Everybody applauded the savings, but chafed under the restrictions. So Congress and state legislatures spent the last decade writing legislation telling HMOs what services they must provide. At first, these legislative mandates called for simple things -- a blood test here, an X-ray there. But before long, legislators learned it was easy for them to score points with certain key groups of voters by coming up with new mandates. Women voters, for example, were courted by politicians who promised that they would never be forced to give birth in what came to be known as a "drive-by delivery." That law was so popular that lawmakers began guaranteeing by law treatment for virtually every clinical condition. Now comes the "mental health parity" bill, which President Bush is expected to endorse this week. In theory, this legislation promises people with private health insurance the same quality of care for mental health as they receive for physical health. Health insurance coverage for mental health is extremely important, especially when you consider that an estimated 20 percent of Americans suffer from serious depression. Thus Bush and other proponents of mental health parity are motivated by admirable intentions. But mental health coverage is also expensive and it will not be available to everyone simply because Congress passes a law. The mental health parity bill is being embraced by Bush at a time when many employers are complaining that the rising costs of health care insurance are threatening their profitability. It's possible that a congressional mandate to cover the huge costs of mental health treatment will cause more employers to stop providing health insurance. Under the proposed bill, you see, mental health parity would be guaranteed only for those people who already have insurance. It would not apply to the estimated 40-million people who are uninsured -- a group with a higher proportion of mental illness. Nor is there any requirement for employers to provide any insurance. Therefore, Bush is endorsing a proposal that would give better benefits to the insured while still ignoring the uninsured. In fact, it's a bill that might cause more people to be uninsured. Of course, HMO executives are wringing their hands over the mere suggestion that they should be forced to provide better treatment for mental health illnesses. Most HMOs and health insurance plans provide some mental health benefits, but they are usually meager. Their opposition is certain to cast the HMOs, once again, in the role of a greedy and uncaring bureaucracy. But there is also a good economic reason for their concern. After all, these are the people who we expect to keep our health care costs under control. "The rising cost of health care is the most important challenge we face in the health care system," said Karen Ignagni, who lobbies for HMOs in her job as president of the American Association of Health Plans. Last week, Ignagni's group unveiled a study suggesting that government mandates added $10-billion -- or about 15 percent -- to health care costs in 2001. "The pendulum has swung too far," says Ignagni.
 © 2006 • All Rights Reserved • St. Petersburg Times
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Times columns today John Romano Sara Fritz |
