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Parity-2004
Archive Action Steps to help you get involved.
Public Policy-Louisiana Mental Health and Substance Dependence Insurance Parity
NOUGH SAID? Disclaimer: I realize that I am “preaching to the choir” for the most part. Perhaps someone will visit HopeWorks.Org and stumble across this puffed up bit of righteous indignation. What does Parity mean? That which is right, fair, equal. In this context, legislating insurance companies to provide Mental Health and Substance Abuse benefits in their healthcare offerings at the same reimbursement rates as for “physical” illness. I put physical in quotes because what the insurance companies rhetoric demonstrates is that they subscribe to outdated idea that the mind and the physical body are separate from each other. In a recent personal communication with one of the editors of the recently published, Handbook of MIND-BODY MEDICINE for Primary Care, Sage Publications, 2003, I was told that the etiology of the physical complaints for fully 80% of patients who show up in physician’s offices can be traced to mental health issues. Further, DeGruy (1996) is quoted in Mind-Body Medicine on the topic of the Indivisibility of Mental from Physical Health states: “Systems of care that force the separation of “mental” from “physical” problems consign the clinicians in each arm of this dichotomy to a misconceived and incomplete clinical reality that produces duplication of effort , undermines comprehensiveness of care, hamstrings clinicians with incomplete data, and ensures that the patient cannot be completely understood. (p.286)” O.K., Choir, one more time and this time with heart. What is the number one health problem in America today? Right, Alcoholism / Drug addiction. Prevention through education is great but if someone has a genetic predisposition (and 10 to 15% of our population does) and is exposed to the ingestion of alcohol….that is all it takes. It sets in motion a process very much like an allergic reaction. Bear with me a minute. Sometimes I go the long way around the bush to get where I am headed. When I was eleven (11) or twelve (12) and I came in contact with poison ivy the first few times in the Boy Scouts, nothing happened. I didn’t seem to be allergic. At age fifteen (15), while working as a camp counselor, assigned to a morning work crew, we were hand cutting a clearing in the woods for a camp fire that night. The acre size area was devoid of trees but grown up knee high with weeds and underbrush. In northwest Louisiana at mid summer, (old Camp Yatasi north of Minden, LA to be exact) it seems that the ecosystem is particularly suited for poison ivy (pi) to thrive. Even in a long dry period, every other weed for miles could be burned to a crisp but not the (soon to be dreaded) PI. If it had a use and we could have bailed and sold the stuff, I could have retired comfortably at twenty-five. Half or more of what we had to clear was the soon to be discovered killer weed. No problem, so I thought. I wasn’t allergic to the stuff so, I peeled off my shirt, grabbed my sling blade and went work with the rest of the crew. About ten o’clock we took a break for water and I was starting to itch. Hot and sweaty cutting green weeds, it seemed normal. Again, no big deal. By the end of our break my skin was the color of a fire truck and I was beginning to hyperventilate. After a ten mile dash to Minden in the camp director’s car, I ended up in the hospital being pumped with fluids and being stuck like a pin cushion with cortisone. I thought it would never stop. The itching was maddening and I couldn’t scratch it or I would tear the large fluid filled blisters and seriously damage my skin. I wished they would take my skin off and I really thought I was going nuts. I still didn’t understand what was wrong with me. The worst part was being delirious for more than a day because I couldn’t make sense out of anything. Finally, my body, with the help of the doctors and nurses, was able to detoxify (remove) the contaminants from my system. I had no forewarning. I thought the plant (but really the oil on the leaves, a substance) was harmless to me. I have been very careful to stay away from poison ivy ever since (Long Term Gain). Perhaps you might call that “a moment of clarity” following a period of Short Term Pain. If you apply my poison ivy story to an individual who is allergic to alcohol, the only difference is that the insanity seems to last longer and they keep going back to roll in the stuff despite the knowledge that they cannot predict whether they have a violent allergic reaction. God love her, Nancy Reagan came up with the “Just say, No!” program during the Reagan years. Her heart was in the right place and her motives right minded. The only problem with the program was that it was meaningless. For the non-alcoholic/addict it is easy to say, “No.” For the active alcoholic/addict, just saying “No!” is meaningless. They won’t/ Have you ever tried to use will power on diarrhea? Well, it only works for a very, very short period of time and then you better be somewhere equipped to handle the situation or you have a mess. When your stomach is upset, you are sick and you need help. What are we dealing with here? Cultural Denial? resistance to change? the archaic belief that alcoholism and drug addiction are a moral problem? The answer is probably some of all of the above. The massive data base of incontrovertible evidence that there are huge savings (Long Term Gain) to be had from lost work, work related accidents, calling in “sick”, poor production following a night on the town, over utilization of medical facilities, early onset physical deterioration and loss of health due to chronic consumption powerful chemicals, and on ad infinitum. Most all of this information was developed by and for Employee Assistance programs as a way of preemptively addressing health concerns. The ironic fact is that these programs are often created by or affiliated with insurance companies. So, they know. The insurance companies know. The information about all of the money, not to mention the cost has been primarily developed by their actuaries. So, if their policy holders had mental health and substance abuse treatment benefits and over the long term were thus utilizing services less, filing less claims, the insurance company gets to keep the premium so, what’s the problem? I believe it comes down to Cash Flow and the “Short Term Gain, Long Term Pain versus Short Term Pain versus Long Term Gain” issue. The more benefits a customer selects the more the policy premiums cost. If there are mandatory components there is less room to negotiate. Kinda’ like buying a used car. If the car dealership took it on trade and allowed $11,000 on the sale, you can bet no one will be buying the car for $10,000. Now, if the dealership only allowed $7000 and it lists for $11000, there is a whole bunch more room to negotiate. In sum, with mandatory coverages, there is just less room for sales people to negotiate and thus, it can be a harder sell (pain). In regard to Cash Flow, if people have the benefits, they will use them and on the front end the insurance companies will have to pay their providers (Short Term Pain) to fulfill the mental health and alcoholism / drug addiction treatment aspects of their obligations. In the short term, the insurance companies to have to dip into their premium pool{pool sounds so small, perhaps we should say PREMIUM OCEAN} to pay the claims (Short Term Pain). Perhaps, the insurance companies don’t want to give up the benefit (Short Term Gain) their sales forces have by being able to remove that front end cost from the policy holder’s premium. I can just about hear the conversation: (having been in sales in another lifetime.)
Insurance. Agent (IA): So, that about wraps it up. What do you say to getting you and your family covered?
Potential policy holder (PPH): Wellllllll. Not today.
IA: O.K., no problem, just let me know when you are ready (gathering papers, proposals, etc.) and we’ll get you that protection. (Standing, as if to leave) Say, may I ask you one more thing?
PPH: Sure.
IA What exactly is it that is stopping you from signing up for the protection you have clearly said you need and want?
PPH: The premium is just too much
IA: Remember, there are a number of options and you don’t have to select all of them.
PPH: OK…….
{You get the picture. How would you imagine the discussion is likely to go when they come to the OPTIONAL Mental Health and Substance abuse portion of the policy? }
PPH: What is this Mental Health and Substance Abuse stuff?
IA: ……………….I think I’ll stop now and just let your imaginations fill this one in because ‘NOUGH SAID!
William C. “Bill” Calkins, LCSW, BCSAC
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