A MAN sees his wife's psychologist after being told that her depression only can be dealt with by including him in the therapy. The man is asked if he wishes to be diagnosed with an accepted mental disorder so that his medical insurance will pay the therapist's bill. This not unusual story points up the Clinton Administration's dilemma as it tries to decide what mental health aspects to cover in its basic health care package: Under what circumstances are "mental illnesses" and their "treatments" both medically justified and politically feasible?
ABC's "Day One" uncovered a scandal in 1994 wherein hospitals in a private psychiatric hospital chain made diagnoses of severe mental illness (e.g., "major depression with psychosis") for insurance purposes before a psychiatric evaluation even was made. The network's consultant, an insurance fraud investigator for Blue Cross/Blue Shield of Georgia, stated: "It's extremely widespread; it happens everywhere."
The potential for all Americans to be diagnosed as mentally ill and qualify for third-party reimbursement leaves the Clinton Administration untroubled as it pursues a policy on mental health care that would cover mental health in a "non-discriminatory" way--i.e., indistinguishable from coverage for physical health problems. The House Education and Labor Subcommittee, reacting to pressure from mental health groups, has voted in support of the Administration's efforts to expand coverage for mental illness to near-parity with physical illness under the national health care plan. People who use decades of psychotherapy to deal with the vicissitudes of life should be thrilled.
Spearheaded by Tipper Gore and her aide, Bernie Arons, formerly of the National Institute of Mental Health (NIMH), the Administration initially sought from the beginning of its health reform efforts in 1993 to cover all mental illness at parity with physical illness. Mrs. Gore, a tireless advocate for the expansion of such benefits, heads the mental health working group of the White House Task Force on National Health Care Reform. Her leadership regularly is recognized in grateful thank-you's from the American Psychiatric Association (APA). Like Mrs. Gore, the APA has been lobbying unremittingly for expansive psychiatric coverage, utilizing a public relations blitzkrieg, as evidenced by a headline in the organization's newsletter: "APA Urges Members to Send Views to Hillary Clinton Now."
The Administration was in a full-court press at the outset for full and unlimited coverage of mental health, which, in some regards, would have constituted even more than the parity with physical illnesses it ostensibly was seeking. A confidential government report, "Health Care Reform for Americans with Severe Mental Illnesses," was quoted in The New York Times in March, 1993, as saying, "contrary to persistent myth, mental illnesses are both real and definable." Moreover, the report went on, "the division of diseases into medical and mental types becomes more arbitrary with every new study."
Then, the Administration appeared to retreat. Early estimates put the cost of parity at fully one-third of all health care outlays. The Administration's health care advisory Jackson Hole Group recommended stringent limits on the number of psychotherapy visitations to be covered. In spring, 1993, Hillary Clinton warned mental health interest groups: "I won't lie to you and say that mental illness will be covered at parity [with physical illness] ... you have to understand that some have argued whether mental illness should be in the package at all." The resulting provision in the Health Security Act promised eventual parity, but provided coverage for 30 days a year of outpatient psychotherapy and inpatient treatment, with limits on counseling therapy for substance abuse.
Fighting back, Mrs. Gore and Frederick Goodwin, head of NIMH, announced findings purporting to show that mental illness is prohibitively expensive, while mental health treatment is cost-effective. …