The Right Prescription

The Troubling Psychology of Health Care

What about mental health services under universal care?

By 9.3.09

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Among the more intriguing, and disturbing, questions swirling around the prospect of government-run universal health care is how the final version of the plan will deal with mental health services. While a senator, President Obama co-sponsored the Mental Health Parity Act of 2007. "Parity," he has claimed, "means that we don't allow group health plans to impose treatment or financial limitations on mental health benefits that are different from those applied to medical or surgical services."

Historically, many insurance companies have limited their coverage of treatments for mental health conditions like chronic depression or bipolar disorder. You'd assume, given his track record, that any bill the President eventually signs would require the government to pick up the tab for institutionalizing and rehabilitating psychiatric patients for at least as long as the plan paid for hospitalizing and rehabilitating, for example, cancer patients.

But the principle of mental health parity also opens a large can of worms. For instance, Obama has stressed the crucial role of "prevention" in improving health care; not surprisingly, therefore, he's been urged by health and fitness organizations nationwide to include funding for physical activities in his plan--to ward off the effects of childhood and adult obesity. But, in the spirit of mental health parity, since physical ailments ranging from hypertension and ulcers to acne and sexual impotence have psychological components, and since more severe mental ailments often flow from less severe ones, wouldn't Obama's commitment to prevention suggest that psychotherapeutic counseling should likewise be covered? Wouldn't psychotherapy count as a preventative measure?

Indeed, the original July 14th draft of the health care reform bill produced by the House of Representatives explicitly stated: "The Secretary of Health and Human Services shall, taking into consideration concerns for patient confidentiality, develop criteria with respect to payment for mental health counselor services for which payment may be made directly to the mental health counselor… under which such a counselor must agree to consult with a patient's attending or primary care physician in accordance with such criteria."

The trouble with that, however, is that there's no scholarly consensus about what psychotherapy's goals are, what its proper methodology consists of, or whether it works better than just ordinary social interaction. If Freudian psychoanalysis and Gestalt therapy are covered, does that mean that art therapy or dance therapy or primal scream therapy should also be covered?

Beyond these lie other dilemmas which future Secretaries of Health and Human Services will likely confront. If psychotherapy can reduce or prevent certain physical and mental illnesses, cannot the same be said of, say, meditation? What about aura cleansing? Crystal healing?

People regularly gripe about insurance companies because insurance companies occasionally say no -- which is a major reason why Nancy Pelosi and company provided House Democrats with a memo before their August recess instructing them to paint insurance companies as villains in the health care debate. But insurance companies operate on a sustainable business model; their default position, therefore, is not to cover treatments without empirical evidence of their efficacy.

Will a government-run health care system, which prioritizes prevention and which is committed to the principle of mental health parity, say no to anything?

Will it bankrupt the nation if it doesn't?

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