"We
have, really, a public health problem that is in some ways becoming
epidemic in proportion,"
Dr. Daniel Angres on the 1/1/03 report on Youth rinking Increase.
ParityPublic
Policy
Louisiana and Parity
By
Dr. Ken Roy, MD
Medical Director, Addiction Recovery Resources of New Orleans
Parity is the idea that insurance coverage
for Mental Health and Substance Abuse should be at the same level as
insurance coverage for other medical illnesses. The present situation
is one in which these areas are either not covered or covered with
arbitrary or ridiculously low limits. The result is a catastrophic
level of confusion causing untold damage to individuals and to the
working people of our state and to their families.
There are several analogies that can be made
to the current situation. What if you could only have treatment for one
heart attack per year or per lifetime? Or, what if you only had
$2,000.00 per year to pay for care for heart attacks and no coverage for
high cholesterol? Or, if you could only have outpatient heart care, or
only inpatient heart care? What if your insurance only paid for those
visits for chest pain that resulted in heart attacks and not for those
that were not life threatening?
The origin of our current system has roots
in a very insidious and difficult-to-dislodge “Moral Model” of addiction
and mental health. This insidious “Moral Model” is the idea that a
person with an addictive disorder can and should ”cut it out” and “get
with it” so that they can resume or accept society’s values and discard
the values of an addictive lifestyle. The unstated principle is that
addicted people are not good people with a bad disease, but bad people
who have decided to continue to drink and/or drug.
A glaring example of the “Moral Model” in
action is the existence of publicly supported clinics in each Parish to
provide treatment for patients with addiction and/or psychiatric
illness. Do we have freestanding, separate, publicly supported clinics
to provide care for diabetes? For high blood pressure? Of course not!
But, it is scientifically factual that these disorders are at least as
self-induced as addiction, depression or bipolar disorder. Furthermore,
the legislature sets aside inadequate sums to fund these clinics, which
then, of necessity, and extending the “Moral Model,” requires that
barriers to treatment exist to manage access (census).
(Note, I do NOT imply that workers in the state
system have a “Moral Model.” They do not. The fine work of the workers
and administrators of state systems is awe-inspiring. But, the SYSTEM
embraces the “Moral Model” by the assumption of responsibility for the
treatment of addiction [and not diabetes, etc.] by the state. The
treatment for medical illnesses should occur within the mainstream of
medicine.)
The existence of the public system as a
primary modality of treatment in our society allows us to vicariously
“punish” those of us with addiction by assuring that treatment will be
less comfortable (overcrowded and under funded), and permits us
to smugly have comfort that we are addressing the “problem.” Our
confusing and unreasonable health insurance and public treatment system
deprives people of treatment until they are so broken that they can’t
easily be fixed. Then, we expect them to access an inadequately funded
system, built on the Moral Model, and expect them then to embrace a
lifestyle of disease maintenance and preventative care. This situation
costs patients with addiction, and all of us, dearly.
As we know, there was a time when patients
were hospitalized for months and even years for psychiatric illnesses,
and patients with substance use disorders were “automatically”
hospitalized for 28 days, and longer if they were difficult. These
programs and this kind of treatment are, fortunately, a thing of the
past. The kinds of expense involved with these kinds of treatment are
behind us. Today we have criteria based levels of care such that a
course of treatment includes fewer inpatient days, if any.
What that means is that patients must meet
recognizable criteria for severity of disease in order to be treated in
the various levels of care. Professional treatment should always last a
minimum of one year, including continuing care (aftercare), but the
intensity of services does not have to be intrusive or expensive. For
instance, a patient with a house, a spouse and a job will actually have
a better outcome if they are treated in an outpatient setting while they
continue to work. People with a greater degree of illness, however,
require more intense treatment over a longer period of time. The
Rand Report and other studies demonstrate that the combination of
managed care and a full spectrum of services for addictive disease will
result in a minimal immediate increase in insurance premiums and a
probable reduction of costs after the benefits of treatment result in a
reduction in other health care costs.
What are the benefits of Parity? They are
HUGE! A great deal of our national budget is spent on drug control,
police work related to substance abuse and efforts at Supply Reduction
at the federal level. However the greatest chance of reducing demand,
and therefore reducing the supply, and also reducing the collateral
damage of drug and alcohol use, will come when working people and their
families have easy, early access to appropriate treatment for
addiction. We could have a big tax cut if we didn’t have to send
helicopters to
Columbia!
It is known that 25% of hospitalized
patients meet the criteria for addictive disease. How much does a
lifestyle of drinking and/or using contribute to the escalation in
health care costs? If we include all of the illnesses caused by
drinking and/or using and all of the injuries caused by drinking and/or
using to the user and others, substance abuse is the third leading cause
of premature death and disability in our country. If we include the
damage caused by living with and loving someone with addictive disease,
the incidence of damage increases.
It is also true that all treatment for
addiction is values-based. While teaching the disease idea of
addiction, treatment always teaches that dishonesty, theft, greed, hate,
lust and anger are components of relapse. Professional treatment
encourages a rejection of those values and an embrace of generosity,
courage, fairness, industry, restraint and wisdom. Would these
attitudes go a long way toward solving the ills of our society? You bet
they would! Since all good treatment includes family, these values
will spread beyond the person in treatment.
Do I believe that Parity will solve all of
the ills of our world? There is no one thing that will solve all of the
ills of our world; however, Parity will help. Parity is simple and easy
to do. Parity can be accomplished by a grass roots effort, aimed at
legislators and officials, to voice the will of the people that we have
it. Parity is a big deal.
Addiction
Recovery Resources of New Orleans, Addiction
Recovery Resources of New Orleans, a non-profit agency that provides a
full spectrum of services from ambulatory detoxification through
intensive outpatient and residential Dual Diagnosis and addiction
treatment.www.arrno.org
More on ASAM "The nation's
medical specialty society dedicated to educating physicians and
improving the treatment of individuals suffering from
alcoholism and other addictions."
Public
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