Mental Health Parity is a Nice Obamacare Gesture, With a Big Price Tag


Sigmund Freud
Public Domain

As Jacob Sullum points out, one of the Affordable Care Act's great failings is President Obama and company's refusal to admit that health coverage involves tradeoffs. Sure, it's upsetting when your copay is higher than you wish, or your policy doesn't cover everything under the sun, but the more you jam into a plan, the higher costs will be, and somebody has to pay for them. So when the government waves its hand and does away with what the president insists are "substandard" plans by mandating a generous wish list of coverage, it makes relatively affordable plans rather less so. The federal government did that in spades last Friday when the Department of Health and Human Services finalized rules enforcing mental health parity—a very expensive mandate—for most private health plans.

The mandate was expected, since it implements the Mental Health Parity and Addiction Act, which has been on the books since 2008, but which dwelt in statutory purgatory for five years because the Obama administration never issued guidance that would allow the law to be enforced. Secretary of Health and Human Services Kathleen Sebelius says her Friday announcement is "building on these rules" when it's actually overcoming a half-decade of bureaucratic inertia to put the law into effect. Because the law has been sitting there for so long, many of its costs may already be represented in the new heath plans available under Obamacare, though those plans might have to be tweaked, since the final rule was issued six weeks after individual plans went on sale on the exchanges. Not that anybody has been able to buy them, yet.

The costs that mandates add to health coverage are no mystery. the Council for Affordable Health Insurance estimates that, while each individual mandate might elevate costs by only a small amount, in aggregate "mandated benefits currently increase the cost of basic health coverage from slightly less than 10 percent to more than 50 percent, depending on the state, specific legislative language, and type of health insurance policy."

Mental health parity—which "ensures that health plans features like co-pays, deductibles and visit limits are generally not more restrictive for mental health/substance abuse disorders benefits than they are for medical/surgical benefits" in HHS terms—is among the more expensive mandates, raising costs by five to 10 percent (PDF), all by itself.

Looking at expenditures, the Health Care Cost Institute found that mental health and substance abuse treatment costs jumped after the passage of the Mental Health Parity and Addiction Act, even in the absence of final federal rules. The study looked at the time period after passage, rather than for a direct causative effect of the law.

That's not to say that people don't need mental health treatment or help with substance abuse problems. But there's no such thing as a free lunch—or free health care. Shedding a tear and promising people that all of their needs will be covered is cheap. Following through, not so much.

(H/T Sevo)

NEXT: Clintons Distancing Themselves From Obamacare For Political Purposes, Conservatives Point Out

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  1. Way to go sevo!

    1. Thank ya, thank ya ver' much!

      1. You join a hallowed group. The initiation begins at midnight. Bring a snakebite kit.

  2. Let me guess. Part a of the mental health screening process: "Do you have guns in your home?"

    1. Damn your quick finger, P! Anyway:

      That's not to say that people don't need mental health treatment or help with substance abuse problems. But there's no such thing as a free lunch?or free health care.

      The asset seizures will pay for it.

  3. "The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics." -Thomas Sowell

    1. Nuh-uh. My progressive Facebook friends tell me that as long as we do things their way, we're headed for a post-scarcity utopia right out of Star Trek. We can install your new replicator in your home next Tuesday between 9:00 a.m. and noon.

  4. So lets see, my health insurance now covers mental health. I guess I will go see that marriage counselor now. I mean I am paying for it anyway. And maybe the wife is right that it will work.

    Does anyone else remember the retards who sat around in 2009 and 2010 telling us how making people buy insurance was going to lower costs? You know bend the cost curve?

    We are making people buy coverage they don't want for treatments they have for financial reasons rationally chosen not to get. So now they will be getting that treatment. But since it is paid for a by an insurance company it totally doesn't count towards total medical costs and no one will be paying for it. I mean the insurance company is a third party payer so it prints its own money. Right?

    1. It's OK, John. Your health insurance now also covers *fiscal* health.

    2. Careful, buddy. There's a high likelihood that any marriage counselor who tells your wife what she doesn't want to hear will be a "quack" who "never even bothered to listen", or some such. At least, by extrapolation of every functioning person I know who probably does have issues, but doesn't actually want to change who I've talked to about mental health "treatment".

      No lie. I've had serious conversations with people who were outraged that the therapist told them to drink less and exercise more for their lack of energy when it was clearly their mother's fault for working or whatever.

      1. It is all a cargo cult anyway. And the marriage counseling was strictly an illustrative example. It was not intended to represent my situation.

        1. It was not intended to represent my situation.


      2. "If you like your issues, you can keep them!"

    3. John, you obviously have signs of anxiety.

      Here you go, take these pills. All better now, right? Now lay your head in Obama's lap while he strokes your hair and thank him for covering your pills.

      1. I'm actually suprised there is not more government assholery around anxiety medication given the lengths they go to ensure no one ever gets relief for pain.

        1. It'll be the next ADHD. Every adult has anxiety, just like every kid has ADHD.

          1. "Every adult has anxiety,"
            Sometimes depression is APPROPRIATE, dammit.

            1. ^This^ Perhaps the reason that you are depressed is because you are a scum bag or a loser. I really can be because of reality instead of a pill deficiency.

              1. Of course, you probably have never seen true clinical depression, like the kind intended for treatment with parity. It's a debilitating condition. One reason mental health gets so misunderstood is the names for some diseases sound like common emotions. Believe me, serious depression is nothing like feeling low.

                Unfortunately, so many internal medicine docs hand out antidepressants like candy, it's no wonder people think they are happy pills.

                1. "Believe me, serious depression is nothing like feeling low."
                  OK, but tell me the objective measures to differentiate.

    4. Well, you raise a good point, John. If people are forced to buy coverage that they normally would never use, why not use it? You're paying for it anyway, right? So you now get mental health coverage; why not hit up the therapist and see how it goes? You're already paying for it, right?

      I love Obamacare. It's so stupidly designed that we are going to be finding out how idiotically they wrote it for years. The hits keep on coming!

      1. This is me, exactly. I am a cheap bastage and don't like expensive doctor bills. When a broken piece of a plate stabbed me in the foot a few days ago I sucked it up and super-glued the wound. If I ever get forced into medical insurance that habit of frugality will go out the window.

      2. Exactly, all of the perverse incentives present in employer-based insurance have now been - INTENTIONALLY - transferred to the individual market.

        We can't have consumers knowing or caring what things cost! If they have a slight whim of a desire to see a therapist, nothing should inhibit them from doing so!

        Except maybe a waiting list!

      3. It is really remarkable in that it is going to achieve exactly the opposite of everything it claimed to do. Instead of getting more people to have health insurance and lowering overall costs, it is going to leave fewer people with insurance and raise costs, all with the bonus side effect of reducing choice and quality of care.

        1. It is really remarkable in that it is going to achieve exactly the opposite of everything it claimed to do.

          And exactly what they intended for it to do all along, which is destroy the system so that they can rebuild it as a Socialist Utopia.

          1. They are not that smart. You give them way too much credit. They are fucking morons. The plan they had depended on the public option being available for people whose insurance got canceled. When the public option was stripped, it ensured the plan was basically insane. But they were too stupid and arrogant to admit that. They thought they would get so much political boost for passing this wonderful plan, they could put the public option back in after they gained big in the 2010 midterms. Of course they lost their asses in the mid terms and there was no way to fix the program.

            They have spent the last three years since the 2010 midterms delaying the inevitable and pretending that if they just hoped enough this thing wouldn't turn out so bad. Yeah, that is what happened.

            There is not some deep long game to get single payer by somehow fucking up everyone's health care and still managing to get them to trust the Dems to run everything. They are not bond villains. They are morons.

          2. I have to agree with John about the Dr. Evil secret plans to bring about single payer. These people are far too vastly incompetent to plan something like that. Even if, deep down, they would actually like to see single payer implemented, I cannot believe that they sat in a (non-smoke-filled) room and planned to do it by implementing the biggest clusterfuck we've possibly ever seen.

            Not only would it require them to sacrifice their egos (which is an impossibility), it would require an actual deep understanding of just how the law would fail so miserably. Shit, we were totally against it and didn't understand how miserably it would fail. There is no way in hell these people are that smart and capable of foresight.

            If this was all a diabolical plan, then these people are not only smarter than we can fathom, they are also willing to sacrifice their public images for some future socialist ideal.

            No. Fucking. Way.

            1. I agree with you two about it not being the plan all along, but it's where they will take it, because what else are they going to do?
              They're not going to admit to failure. They're not going to go the other way, as they only know one direction - Needz moar centralized control and needz moar spending.

            2. After Coca-Cola replaced their product with New Coke in the early 80's, there was the huge shitstorm. They were smart enough to bring back their old product. The huge controversy meant that there was a great deal of interest generated for the company, and sales wound up rising.

              The media asked the President of Coke if they had actually planned that all along. His reply was "We're not that smart, and we're not that stupid."

              He was right. They weren't stupid. Coke had done the largest (to that time) ever study of consumer preference before releasing the new product. They did their homework. It just didn't pan out (for the new product), because they got rid of a product people liked, and didn't take into consideration non-taste factors.

              The politicians aren't that smart, but they are that stupid. They took away something that was working for the vast majority, and replaced it with a pile of shit.

  5. After the exchange this morning, I thought more about this:
    WIH would anyone buy insurance for this? There are no mental health treatments that break the bank like, oh, open-heart surgery.
    People griping about how medical treatment is the #1 cause of bankruptcy didn't jam this into the pork barrel.
    (And it should be #1; what else is so important?)

    1. Why by any insuarance? Pre-existing conditions are now covered.

      1. Why by any insuarance? Pre-existing conditions are now covered.

        You can't be denied for a pre-existing condition, but you CAN be denied until the next open season. So if you get cancer the day after open season ends you have to wait about 11 months (or until you can get married or have some other major life change).

        1. That can't be true, as I don't recall Obama every qualifying his promise that you can't be denied health insurance due to a preexisting condition.

          1. "I don't recall Obama every qualifying his promise"
            This is all a big misunderstanding.
            When he's speaking, you have to look closely near his side. There's a mirror behind him, and a careful examination shows that his fingers are crossed.
            Every speech!

            1. There's a mirror behind him, and a careful examination shows that his fingers are crossed.
              Every speech!

              To be fair. Obama knows that we know he's a politician and everyone knows politicians can't be trusted. In his mind it's not a lie if you should already know it's not true.

          2. As I said, no one can be denied coverage due to a pre-existing condition. Anyone can, however, be denied coverage due to a few other arbitrary factors such as time of year and recentness of marriage. No lies. Just incomplete truths.

    2. Uh, I was temporary guardian of a teenager that developed full blown bi-polar disorder in her mid-teens. Three weeks in a locked ward in the hospital to get her on Lithium and at the right dose is pretty big fucking bill.

    3. Well, that's not entirely true. I'm not supporting O'care here, only saying that there are serious conditions that require hospitalizations and expensive medications. Many people with mental illness would be more cheaply taken care of by being institutionalized rather than incarcerated (a typical fate) and/or using other social services.

      1. "Three weeks in a locked ward in the hospital to get her on Lithium and at the right dose is pretty big fucking bill."

        "Well, that's not entirely true. I'm not supporting O'care here, only saying that there are serious conditions that require hospitalizations and expensive medications"
        OK, but the problem I have here is that for every 'really need it' there seem to be 100 'I hate my daddy's.
        Is O'care gonna differentiate?

        1. Almost no therapists take insurance because the reimbursement is so low. It's pretty much a cash business. Don't worry, just because people have coverage doesn't mean they will be able to use it.

          1. "Don't worry, just because people have coverage doesn't mean they will be able to use it."
            Well, that doesn't help much. We're paying to supposedly help people and we might just as well pound it down a rat hole?

  6. "Substance Abuse": Indulging in pleasurable but physically damaging chemical use. No way that subsidizing that could have unintended consequences.

    1. It doesn't even have to be physically damaging. If you enjoy it then you're abusing it.

  7. I've always considered mental health counseling to be a way for quacks to make money off losers who don't have any friends.

    1. Eh, some people got raised/live around seriously fucked up individuals and pick up habits that make their lives much worse than they have to be. You'd be surprised how many kids with drunk parents (like parents who drank so much they couldn't hold a job, not parents who split a bottle of wine with dinner) grow up to have really fucked up ideas about how to have a relationship. Maybe that's "life coaching", but its still just applied psychology.

      1. And if those people weren't losers without friends, maybe their friends would point out those bad habits to them.

        1. Well, okay. Stand in front of that plate glass window and throw rocks at loser loners.

          1. I'm sorry if you resemble my remark, but I stand by it. Had a gf who was a psych major, and both her parents were in the business. Not that I had any respect for it before hand, I didn't have any after.

          2. A hit of acid does much more good for introspection than some douche with a clipboard who says "Uh huh" a lot.

            1. Wow. This is awesome. Its like a unicorn to discover an actual Freudian aversion based on sex or the lack of sex.

            2. LSD and MDNA have both shown real clinically verifiable results in treating people with PTSD and bipolar disorders. But since someone might use those drugs to have fun, we can't allow them to be used to help people. We have to protect the children you know.

              1. Don't forget psilocybin.

    2. I mentioned ADHD above, but look at the symptoms from NIMH website:

      Get distracted easily and forget things often
      Switch too quickly from one activity to the next
      Have trouble with directions
      Daydream too much
      Have trouble finishing tasks like homework or chores
      Lose toys, books, and school supplies often
      Fidget and squirm a lot
      Talk nonstop and interrupt people
      Run around a lot
      Touch and play with everything they see
      Be very impatient
      Blurt out inappropriate comments
      Have trouble controlling their emotions.

      Is that ADHD, or I don't know, BEING A FUCKING KID.

      1. Real ADHD is a treatable mental condition that has profound impacts on the ability of a person to function without medication.

        Fake ADHD is either parents who won't parent or teachers that won't teach.

        1. Fake ADHD is also adults obtaining the benefits of legal speed. Pharmaceutical grade speed taken in moderate doses is a wonder drug. People feel better, lose weight, are more productive and generally healthier and happier. Thanks to the DEA, adults have to convince their doctor they have ADHD to enjoy these.

          1. Well, the FDA, too. If I could just buy speed from any reputable purveyor of generic pharmacological substances, chances are it would be cheap, safe, and plentiful.

            1. It is now. It is called adderall. And all of the meth and speed horror stories are the result of people taking Mexican shoe scrapings sold as speed and manufactured by retards using agricultural chemicals in the backs of cars. Those effects are from the impurities in that crap not from the speed. If people could buy pure stuff made by actual drug companies, those effects wouldn't happen.

              1. I don't know if you've priced the stuff, but even with good insurance, its over a dollar a pill, closer to $5 if you get the non-generic stuff. It probably costs about a penny to make, a penny to package and another penny to deliver each pill. So I would guess I should be able to buy a bottle of 50 at Walmart for $2.95 plus tax in Libertopia.

                1. It probably costs about a penny to make,

                  Several hundred million to develop, test, and pass FDA approval spread over the sales during a the life of a 20-year patent. They still make shitloads of money off the meds, but it ain't no 99% margin.

                  1. Eh. I've already tossed out FDA costs in Libertopia. So several tens of millions to develop and test, which shaves the cost by an order of magnitude. Somehow they make Tylenol at that price.

                    1. Take out prescriptions, and the market size for any given drug goes up by 2 or 3 orders of magnitude.

                      Even with patents and exclusive rights, a thousand-fold increase in the market reduces the cost of a single dose of the product.

        2. Even real ADHD isn't as awful as it's sometimes made out to be. There are other ways of coping and compensating that have nothing to do with medication.

          I realize I'm veering close to the "Suffering Builds Character!" argument, but sometimes the best way to manage a bad memory, a short attention span, and poor social skills is to fail, learn, and adapt.

          Between ADHD and aspergers we've given bad people broad power to turn a lot of normal kids into walking pathologies for life. And they won't stop when they're no longer children.

          1. Even real ADHD isn't as awful as it's sometimes made out to be

            Yes it is.

            Send your teenage kid to the kitchen to bring you back a soda and then they never return, because your instruction has disappeared from his/her brain by the time he/she steps out of the living room.

            Completing any task is not possible without constant external guidance.

            This is not a behavior problem. This is a full-blown, "brain does not function properly" problem.

      2. Fuckit. I used to worry that getting on the Adderall train by claiming ADHD would be a "pre-existing condition" used to charge me more for insurance, but now... I'm totally talking to my doctor about it.

        1. There was this guy I was good friends with in high school that used to love doing dextroamphetamine. We'd buy big bags of it from a lunch lady, and or, kids who were on it but didn't take it.

          When he went to college he made it his mission to get a script, so he went to a doc to be tested. After trying the stupid pills that no one wants he was prescribed dexies. All in all in took a couple months.

          If I have to buy insurance, I may do the same thing. I'd also get some ambien for the insomnia and some xanax for my "anxiety".

          1. You really want your "private" medical records {that can be seen by lots of people (bureaucrats mostly) and is totally exposed to hacking} to document your mental illnesses?

      3. I've always been curious to find someone who was tested for ADHD and tested negative.

        Until then, I think it's just an excuse to get parents to pay to put their kids on drugs.

        Also, is it a coincidence that I immediately thought of The Rats of NIMH when I read "NIMH website" above?

        1. The way it is supposed to work: 1) Real behavioral issues are identified by parents (and possibly by teacher); 2) Trained medical professional interviews the subject; 3) Trained medical professional prescribes meds and then follows up many times with the subject.

          The way it happens way, way to often: A) Parent wimps out and demands doctor prescribes meds or B) Teacher wimps out and demands parents demand doctor presribes meds under threat of de facto expulsion of kids. Then the kids get drugged into submission.

  8. I'd rather pay for a few weeks of substance abuse counseling then for years if prison not that I want to pay for either nor will that likely be a choice. I'll no doubt be paying for both.

  9. The best thing we can do for mental health is STOP SUBSIDIZING AMERICAN UNIVERSITIES.

    With the postmodernism and all the other mindless nonsense that is taught today, if you're not a neurotic when you go into college, you're sure as hell gonna be when you come out of it.

  10. That's not to say that people don't need mental health treatment or help with substance abuse problems.

    I realize that there are some mental health problems that are genuine physiological disorders of the brain. But in our earnestness to treat everyone, and everything equally and without judgement, we are actually crippling people's ability to pay for real, physiological, solvable health problems, like liver cancer and appendicitis.

    Honestly, I don't see why we either need, or want, or ought to have "parity" between heroin addiction and uterine cancer. It's a prejudice that these things need to be treated equally. We live in a world of limited resources, and if you're going to give heroin junkie more money to treat their addiction that necessarily means less money for people who have curable physiological health problems. There OUGHT to be priorities, and treatable physical conditions OUGHT to have priority over mental health and substance abuse.

    1. And lets not forget the perverse incentives created by universal coverage for mental health. More than a few people have been told they are "addicts" right up until the moment their insurance runs out.

      1. That's very true.

  11. I think it's a bait and switch. The rhetoric about this policy will be about serious problems like bipolar and the rest, but once implemented, there will be a lot of anxious people using the benefits. It's like how the birth control mandate was sold in part with all the stuff about how "birth control isn't just for birth control, it cures cancer too!" Then birth control gets used for birth control like anyone could have predicted. The bipolars may be no better off than before, though it's *possible* they might be.

  12. The Patient Protection and Affordable Care Act should be renamed the Patient Protection, Affordable Care, Magickal Thinking, and Flying Unicorns for Everybody Act.

  13. This gets into how the whole thing really IS socialism, in spite of all the derision of that claim by the law's supporters. Everyone pays the same rate, everything is covered, soup-to-nuts. If we all paid a flat fee for the grocery store each month and got to take whatever we want, regardless of how much we eat or how many kids we have, wouldn't that be socialism? The ACA socializes health care costs by forcing everyone to pay community rated premiums into a system that covers everything. It is socialism.

  14. Argh! I have to get this out again.

    I mean, we're sitting here talking about people getting mental health treatment, at the same time we're hearing stories about 60 year old women losing their out-of-network coverage and having it replaced with maternity care.

    That is not just a theoretical tradeoff. It is an actual, real, live, tradeoff that is happening RIGHT NOW for millions of people. Mental health coverage IN, out-of-network coverage OUT.

    Millions of people are losing their ability to see an out of network doctor for a real, treatable, diseases, so that other people can get substance abuse treatment.

    That is a FACT. That the ACA has forcibly imposed a system-wide choice upon million of people. They won't be able to see the doctor of their choice for a genuine physiological illness. The ACA made the decision for them, that other people's therapy is more important than their ability to see a specialist for their cancer treatment.

    1. And, just to top it off, the people with mental health issues won't be able to see _their_ doctors of choice, either. This is a serious problem, perhaps even more serious than a forced change of GP.

      You like that therapist you've seen every month for years? Do you value the care of the doctor who intimately understands your meds and dosages? Too bad. Out Of Network now.

  15. I probably need treatment for paranoia, because I think the primary reason this was implemented is the one The Late P Brooks mentions at the beginning of the thread.

  16. Good commentary.

    Obamacare will exact a high cost not just monetarily but also in terms of Americans' overall health.

    "People respond to incentives, although not necessarily in ways that are predictable or manifest. Therefore, one of the most powerful laws in the universe is the law of unintended consequences." -From the book "SuperFreakonomics"

    That in mind, see:

    "Obamacare: Making a bad situation worse"

  17. Just like "a chicken in every pot". Its a nice philosophical think that we should try to do. Just not inexpensive to accomplish. What (if anything) would Obama give up? Unemployment? Food stamps? Defense spending? Social Security payments? Probably none of the above. He would rather increase taxes on the wealthy minority than require the poor majority to make even a single hard choice.

    Liberals........ sheesh.

    1. Libertarians think there should be pot in every chicken, lol


  18. If you like your sanity, you can keep your sanity.

  19. Forget the money, including mental health "services" in your insurance means _someone gets paid to put you in the loony bin_. Someone gets paid to take you down the "recovered memory" garden path. Not a good idea.

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