President Bush, in yet another slap at the free-enterprise system, wants to force health-insurance companies to cover mental illnesses in the way they cover bodily illnesses. This is known as “mental-health parity.”
According to the Washington Post, the psychiatrists in the audience applauded when Bush made his announcement. No kidding. They stand to reap big bucks if such legislation passes.
By what authority does the federal government order insurance companies to provide a particular kind of coverage? I thought we believe in capitalism in this country. There is nothing to prevent buyers and sellers of health insurance from bargaining to include any services they want. Some policies already include psychiatric services. Why is coercion advocated?
Because the price of the coverage is higher than people want to pay, and these days if you can’t get something you want through persuasion, you turn to force—more precisely, you ask the government to do it for you.
One problem is that few people buy their medical insurance directly. The tax laws make it advantageous to get insurance through one’s employer. But it comes at a cost: someone else does the buying. That can never be as good as tailoring a policy for oneself.
If Bush gets his way, many employers may drop medical coverage altogether because it will be too expensive. Employees who lose their insurance because of the push for parity obviously will not be better off.
Advocates of parity say the cost will not be large. But they are the same kind of people who thought Medicare’s budget would be a fraction of what it is today.
As psychiatric critic Thomas Szasz has pointed out, the call for mental health parity is peculiar because it would be the first parity ever sought by the mental-health industry. Despite the repeated claim that mental illnesses are like other illness, mental patients are not regarded as equal to medical patients. Outside of psychiatry, no one can be labeled a patient against his will. No one with diabetes has to see a doctor and accept treatment. But people are routinely labeled “schizophrenic” against their will. Worse, they can be incarcerated (“hospitalized”) and forcibly drugged. If we are serious about parity, let’s start with diagnosis and treatment: neither should occur without informed consent. (As Szasz points out, imposed “treatment” is not treatment at all; it’s assault.)
It’s ironic that a president who says he’s for limited government and individual freedom not only accepts forced hospitalization of people who supposedly have diseases like any other, he now wants to extend coercion to insurance companies.
One reason insurance policies with full coverage for psychiatric services will be so expensive is that diagnosing so-called mental illnesses is not a species of medical science. Schizophrenics and manic-depressives are not diagnosed according to objective physical pathology but rather according to psychiatrists’ judgments about the things they say and do. Obviously, the mind is not a physical organ—therefore it cannot become diseased. Thus, as Szasz has long noted, mental illnesses are metaphorical illnesses and psychiatry is about “controlling deviance, not curing disease.”
But aren’t mental illnesses brain diseases, as we are often told? If so, why haven’t the psychiatrists turned their practices over to the neurologists (brain doctors) and gone on permanent golfing vacations? The irony, as Szasz pointed out recently, is that bona fide brain diseases (such as epilepsy and Parkinsonism) are covered by insurance. “Neurologists and neurosurgeons do not lobby for parity insurance for their patients because insurance companies have no special exclusions for patients with neurological diseases,” he writes. “Only psychiatrists lobby for such ‘parity.’”
The sponsors of a parity bill, Sens. Pete Dominici and Paul Wellstone, both have relatives diagnosed as mentally ill and both have played this card prominently. Why is it wrong for energy companies to push legislation in which they have a direct interest, but okay for senators to do the same thing?
Our politics and our medicine will match our ideals of freedom and dignity on the day when coercion is banished from both realms—and not a day sooner.