Just the Facts

1. It is estimated that some 58 million Americans, about one quarter of all adults in the US, experience the disabling symptoms of mental disorders each year. From people ages 15 to 44, mental disorders are the leading cause of disability.

2. Success rates for treatment has increased in recent years: 70-80% for depression, 70-90% for panic disorders,  60% for schizophrenia, and over 80% for clinical depression.

3. Extensive limits on mental health benefits can create major financial burdens for patients and their families; for a family with mental health treatment expenses for $35,000 annually, the average out-of-pocket burden is $12,000. For a $60,000 annual expense, the burden averages at $27,000.

4. In 1998, SAMHSA reported that adding children would result in a cost increase of 0.8%, and that creating substance abuse parity would increase costs by as little as 0.7%.

5. Expenditures from failure to treat addiction cost $300 billion. Untreated addiction costs six times more than heart disease, six times more than diabetes, and four times more than cancer. 

6. CALDATA found in 1999 that every $1 spent on treatment of mental health and substance abuse disorders saved state taxpayers $7 in future costs (emergency health care, imprisonment, court cases, etc. )

7. Lost productivity and earnings due to illness and social costs are estimated to total at least $113 billion annually. Clinical depression alone costs the US $43.7 billion annually, lost earnings due to depression-induced suicides totaling $7.5 billion.

8. Parity would extend insurance coverage to additional disorders which were formerly deemed not "severe enough": post traumatic stress syndrome, anorexia and bulimia, multiple personality disorders, and serious juvenile mental and emotional disturbances. 

9. Only one third of individuals struggling with addiction receive treatment. Insurance companies have cut benefits for addiction treatment for less than a quarter compared to in the early nineties. 

10. When mental health insurance parity was introduced in Vermont in the late nineties, Vermont residents with sever mental illness reported real benefits and savings because of the smaller co-pays and increased access resulting from the enactment of the legislation. 

What the Experts Say

Vermont governor Howard Dean, MD:

"Treating mental health problems early is less expensive, more effective, and more humane than waiting until people with serious mental illness end up in a hospital or jail cell."

Senator Paul David Wellstone (D-MN):

"Too often, a cloak of secrecy has surrounded the problem, causing people who have these diseases to feel ashamed and afraid to seek treatment for their symptoms for fear that they will be seen as admitting to a moral failure or weakness in character. 

A Report of the Surgeon General:

"Case studies of five states that had a parity law for at least a year revealed a small effect on premiums - at most a change of a few percent plus or minus."

"... evidence on the effects of parity shows that their costs are minimal."

Nancy Pelosi, Speaker of the House:

"Illness of the brain must be treated just like illness anywhere else in the body."

Argument #1: Mental health is just as important!

The main argument I am using to support my position in favor of parity for both all kinds of mental illnesses and for substance abuse as well is that these types of mental disorders are equally, if not more, detrimental to the American population and deserve to be treated in the same way as physical ailments. Many statistics show that the effects of these diseases and problems are very realistic, and impede the lives of millions of people daily. Thus, it is equally essential that Americans receive treatment for mental health as it is for physical health. In fact, due to advances in the understanding of the brain's chemistry, treatment for serious mental illnesses such as clinical depression have very high success rates, even higher than some physical ailments such as heart disease. It has also become clear that using comprehensive behavioral treatment has yielded a higher success rate for drug addicts, and that it is necessary for these individuals not only to undergo detoxification. Many members of Congress agree on this fact, including Speaker of the House Nancy Pelosi, who says that it is certainly time to level the playing field for these types of diseases.

Sides of the Parity Question

Bringing health insurance to the parity level for mental health and substance abuse is a topic of much debate. A lot of support for such legislation has come from Congress, which has passed bills to reach this goal throughout the nineties and today. Many argue that a stigma, or negative connotation or marking, has surrounded mental illness and that inequity in insurance coverage contributes to discrimination against people who need treatment or cannot afford it. Similarly, parity is perceived by many as a necessary step in solving substance abuse problems by allowing people to get effective treatment that they otherwise would not be able to afford and therefore be treated as more of a criminal than a patient. Opposition to this type of legislation is mostly economically based; many argue that parity would cause insurance costs to skyrocket. In reality, though, parity makes economic sense. And this is not the only reason I am taking the position in support of such action; mental health is clearly, clearly just as important, if not more important, than physical illnesses! Mental health problems, from anxiety in children to substance abuse, affect millions of Americans every day. How can we deny effective, economically logical treatment to those who need it?

Cons

• Many opposers of the 2008 bill proposed in the House said the legislation would drive up costs.
• Drug addiction is a lifestyle decision and result of moral failing and personal mistakes, and people should not have to pay for insurance parity for this group of patients. 
• Businesses will be faced with the choice of covering every single mental or substance abuse disorder listed in the diagnostic manual or none at all.
• How can it be ensured that the clinical care will be appropriate and effective, and that patients have access to reasonable services that will return them to a level of normal functioning as quickly as possible?
• Recovery from these types of illnesses are unpredictable, long-term, costly, and in some cases, unnecessary. 
• There is much transparency surrounding medical necessity criteria. 
• The budget will have to be adjusted to find an offset for the measure's $3 billion price tag.
• The House bill of 2007 mandates insurance companies cover all disorders listed in the American Psychiatric Association's manual.
• One study found that the proportion of employees with coverage for mental health care increased from 1991 to 1994. 

Pros

• Insurance companies that don't offer parity are discriminating against those with the disease of addiction and other mental disorders. They are denying people the right to be responsible for their own health care.
  
• The decision by many insurance companies that treatment for addiction and other mental disorders is "not medically indicated" is medically unsafe and unrealistic; true addicts and individuals suffering from psychiatric disorders NEED medical care!
  
• In 1998, it was estimate by the actuarial firm Milliman & Robertson that the additional coverage would increase health insurance premiums by 0.5%, or less than $1 per enrollee each month.
  
• Parity would not require health plans to offer substance abuse benefits; instead, it would require plans that already cover chemical dependency to treat it equally with all other covered illnesses.
  
• After treatment of addiction, absenteeism, disability days, and disciplinary actions are shown to decrease by more than 50%.
• Addiction is the root cause of many other health problems, and this needs to be recognized so that many of these other problems can be prevented.
• In 2003, Vermont governor Howard Dean, MD, stated in his mental reform agenda that, "Treating mental health problems early is less expensive, more effective, and more humane than waiting until people with serious mental illnesses end up in a hospital or jail cell. "
• Individuals with severe mental illnesses living in states with mental health parity reported real benefits and savings because of the smaller co-pays and increased access resulting from the enactment of the legislation. 
• President Bush described the public treatment system for mental disorders as deeply troubled and inefficient. 
• At a 1999 white House Conference on Mental Health, Dr. Wayne Burton, the medical director of Banc One, reported that parity actually reduced expenses by making treatment more available earlier in the diagnostic process.
• Three decades of advances in psychiatric research have made diagnoses more accurate. Furthermore, the success rate for treatment has increased: 70-80% for depression, 70-90% for panic disorders, and 60% for schizophrenia. In contrast, heart disease has an overall treatment success rate of only 45-50%.
• Speaker of the House Nancy Pelosi said in regards to the 2008 bill on mental health parity that, "Illness of the brain must be treated just like illnesses elsewhere in the body". 
• Not offering equal coverage would negatively impact many of the 35 million Americans who experience disabling symptoms of mental disorders each year. 
• Researchers have found biological causes and effective treatments for numerous mental illnesses.
• A number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. 
• Some doctors say that the stigma of mental illness, a disabling obstacle to millions of Americans seeking treatment, has faded as people see members of the armed forces returning from war with trauma-related mental disorders. 
• Mental health and substance abuse parity is an issue of civil rights. 
• Mental health concerns are highly prevalent, affecting about one quarter of all adults in the US, with variable but often very high impact on health and productivity. Such disorders are generally treatable, as long as patients have access to mental health care coverage and to a behavioral heal provider. 
• Parity benefits all sides of the healthcare system: it allows flexibility for planning care, has a modest impact on cost, and reduces the likelihood that coming to or staying in necessary services is obstructed because of financial barriers to care. 
• Parity of mental health and chemical dependency services, when combined with effective care management, can lead to greater fairness and insurance protections without significant adverse consequences for health care costs. 
• Would require insurers that cover mental health and substance abuse disorders to do so on par with medical and surgical procedures. 
• According to a 2007 bill passed by unanimous consent in the Senate, insurance companies have the flexibility to determine which mental health disorders and conditions to cover. 
• Addiction costs our society a lot more when left untreated. Expenditures from failure to treat addiction costed approximately $300 billion in 1999. 
• Untreated addiction costs six times more than heart disease, six times more than diabetes, and four times more than cancer. Denial of coverage makes little financial sense!
• The Rand Corp. found that unlimited substance abuse benefits cost employers only 43 cents per month. They concluded that, "Limiting substance abuse benefits saves very little... but affects a substantial number of patients who need additional car. "
• Treating a disease as a crime does not cure the disease; medical principles must be applied to addiction.
• An average working-class person struggling to pay the bills and be responsible for their own health care problems probably has little or no coverage for addiction or alcohol problems. This is a crisis in not only insurance coverage but in personal responsibility.

Drug Addiction, Psychiatry, and Equal Coverage

Congress has gotten closer and closer to advocates' demands for parity for mental health and substance abuse. What does parity mean with respect to healthcare?

Mental health and substance abuse benefits are provided at a much lower level than insurance for general medical care. Many view this fact as discriminatory. One reason for this is the fact that insurers worry about attracting really expensive people to their health plans. People with disorders and chronic conditions like an eating disorder or opiate addiction, face immense year to year costs in recovery. 

Parity is viewed as a way to provide important financial protection for people with these disorders. Many supporters contest that insurance companies have treated the brain with significantly less importance than other body parts. But is an increase in treatment coverage really the answer? Perhaps, regarding substance abuse, the increased ability for affordable treatment will lower the number of people who physically quit their addiction. And with the controversy surrounding the over-diagnosing of mental illnesses, would this provision be abused?

Despite the many issues that surface in respect to mental health and substance abuse parity, it should be recognized that substance abuse and other psychiatric disturbances are major health problems that affect millions of people. It is clear that these disorders should be treated just as important as other health conditions.