The Clinton Administration is likely to place insurance coverage for mental disorders on an equal footing with coverage for physical ailments, a move that could dramatically expand the availability of treatment for millions of Americans suffering from various forms of mental illness, Tipper Gore said Wednesday.
Although Mrs. Gore--wife of the vice president and mental health adviser to the White House health care reform task force--emphasized that no decision has been made, she said task force members who will draft the final health care reform proposals are being urged by a wide array of experts to make the change, a move she avidly supports.
"Why should a woman with diabetes who needs insulin have it covered by insurance, whereas a woman with manic-depressive illness who needs lithium not be covered in the same way when both diseases can be managed and controlled?" Mrs. Gore asked in an interview with The Times.
"What we are arguing for is parity with physical illness," she said. "It's a question of fairness."
At any time, as many as 18% of Americans, including 14 million children, suffer from a diagnosable mental disorder, the American Psychological Assn. asserts, and as many as one in five Americans will experience at least one episode of major depression during their lifetimes. Moreover, mental health treatment costs about $147 billion a year--a sizable portion of the nation's $700-billion annual health care bill.
Now, many insurance plans offer no mental health coverage at all or coverage that is substantially less than that for physical problems. Plans that do provide coverage typically will pay for the full cost of hospitalization but with stays often limited to about 30 days. They also typically severely limit outpatient services, such as doctor visits, sometimes to as few as 20 a year. And they often require extremely high co-payments for outpatient services, which can discourage individuals from seeking sufficient help or from continuing treatment.
Mrs. Gore, who earned her undergraduate and master's degrees in psychology, long has been active in mental health issues, particularly those involving children and the homeless. She chairs Tennessee Voices for Children, an organization that promotes services for youngsters with serious behavioral, emotional, substance abuse or other mental health problems. She also is co-chairwoman of the Child Mental Health Interest Group, a group established by the National Mental Health Assn.
In drafting a policy for universal health insurance coverage, the Administration almost certainly will include mental health services as part of its core benefit package, Mrs. Gore said.
"I think it's very important that people who need some kind of mental health help get it," Mrs. Gore said. "They wouldn't sit in bed with a 104-degree fever and not get treated. They should think about mental health disorders in the same way."
Mrs. Gore and others said this approach has received even greater impetus in recent years as a result of research showing that some serious mental disorders--such as schizophrenia and manic-depressive illness--are biochemical in nature and often can be treated with drugs.
"Most mental illnesses are controllable and treatable," Mrs. Gore said. "We have seen this clearly." Years ago, a person diagnosed with schizophrenia "was sentenced to be in a state hospital for the rest of his life," she said. "That has changed dramatically."
Today, such individuals have been treated, "are functioning in jobs," and "have made remarkable strides," she said.
Nevertheless, neither the health care system nor public awareness has caught up with that progress, Mrs. Gore said. She said she agrees with mental health experts who have complained for years that treatment for mental disorders has been the "stepchild" of health benefits, subject to many more restrictions and limits than other illnesses.
"I'd go as far as to say 'orphan,' rather than stepchild," Mrs. Gore said. "A stepchild is still part of a family, with some care. Many people (who need mental health services) are left out in the cold."
Although no decisions have been made about the extent of mental health coverage under the reform proposals, Mrs. Gore and others predicted that mental health treatment would not be given short shrift.
The task force "will have to consider flexibility and cost containment measures, but they will be applied equally," she said. "If you have to have some kind of limited service, the limitations won't only affect mental health. Mental health will not be singled out. The limitations will be applied across the board.
"We want to increase coverage for people and cover mental health in a way it's never been covered before."
Mental health benefits also are likely to be restructured to place a greater emphasis on a "community-based continuum of care," including outpatient care, partial hospitalization and other services, she said.
The move would represent a shift away from the current system, which often encourages expensive hospitalization, while discouraging less expensive outpatient services.
Now about 80% of mental health funds are spent on inpatient care--which is often fully covered by insurance, the psychology association said. At the same time, less expensive outpatient services are underused, and reimbursements for outpatient treatment are often restricted or combined with a high co-payment, the association said.
Although details have yet to be worked out, "there is a consensus that this has to change," Mrs. Gore said.
Unlike many constituencies in the health care reform debate--who have complained about being left out of the process--mental health experts said they believe that they have a sympathetic ear in the White House.
"All of the major mental health groups have been meeting for several years, and we believe that health care reform without mental health benefits is no reform at all," said Jerilyn Ross, a psychotherapist and president of the Anxiety Disorders Assn. of America. "For the first time we feel we have a White House that is being responsive to us."
In addition to Mrs. Gore, Ross and other proponents said they have found an ally in Robert Boorstin, White House spokesman for the task force.
Boorstin, who speaks openly of his own experience with manic-depressive illness, agreed with Mrs. Gore and outside professional groups that mental disorders must be given the same attention as physical ailments.
Boorstin described an incident in 1988, when he suffered his second delusional episode--the first had occurred a year earlier. He had been taken to Massachusetts General Hospital and was awaiting transfer to McLean Hospital in Belmont, Mass., which specializes in the treatment of mood disorders. But his private insurance coverage had run out and he was told that he could not be moved.
"I'm strapped to a gurney, while my brother had to guarantee $18,000 on his American Express card" to enable his transfer to McLean, he said.
"But if I'd had heart disease and had suffered my second heart attack, I'd have been covered fully," he said.
Boorstin, who now takes lithium and other medications to control his illness, said he expects the Administration to emphasize a preventive approach to mental health treatment, much as it has with overall medical care. Such services will be effective "in the same way that immunization is," he said.
"People don't know how much money we can save if we do it up front. It costs a fraction" of the expenditures incurred by waiting, he said. "We will prevent hospitalizations. . . . We will save many lives. And we will save tons of money in the long run."
Boorstin said health care reform "won't be a panacea for people with mental illness," but "the mere fact that mental illness is being considered as part and parcel of health care reform is revolutionary in this country."
NO CLOSED MEETINGS: Judge rules that Clinton health panel must meet openly. A14