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The Push for Parity in Mental Health Coverage

July 13, 2002

"Mental Health Insurance Parity Is an Empty Notion" (Commentary, July 8), by David Cohen and Keith Hoeller, is misleading and dangerous. Diagnoses in psychiatric medicine are made in the same manner as other medical illnesses. A history is obtained, symptoms are reviewed, a physical exam is done (in in-patient settings, primarily), laboratory data are collected and a diagnosis is made. It is true that psychiatry has very few laboratory tests, but other branches of medicine are in a similar situation.

For example, many neurological diagnoses are made by history alone, and almost any experienced physician in any field of medicine will tell you that the history is the most important part of the diagnostic interview.

The Diagnostic and Statistical Manual of the American Psychiatric Assn. dates from 1952. It has become more well known precisely because it has become more useful and scientific.

As far as involuntary treatment goes, this is a public health and legal issue more than anything else. The legislature in every state defines the scope of practice of mental health professionals and creates mental health law. I've never met a mental health professional who wanted to place a person on an involuntary hold; rather, it is with regret and a sense of duty, and in California there are legislatively defined rules about dangerousness to self or others or being gravely disabled.

Marc D. Graff MD

Chair, Public Affairs

California Psychiatric Assn.



Cohen and Hoeller propose that American medicine abandon mental illness. Their main argument is that it has been neglected in the past. However, mental illnesses are difficult to separate from other illness: They are disorders of an organ (the brain) that are common, disabling, often lethal, mostly easy to diagnose and increasingly responsive to treatment. Their indirect costs to the nation, in the billions of dollars, have been well documented.

The public, the families of affected individuals and organized medicine will continue to reject the proposition that mental illness should be selected for denial of appropriate care.

Rodrigo Munoz MD

President, San Diego County

Medical Society


Put yourself in this picture: You're a business owner. Profits influence your bonus, even employment. Tomorrow you will be required to underwrite mental health parity, newspeak code for raising health insurance premiums to pay for real and alleged mental illness. Which psychiatrist will cull the malingerers and opportunists from your staff? Which medical board will police psychiatrists dipping into this well?

Your logical response, even your duty to family or stockholders, is to a) cut back your company's traditional coverage of physical illnesses so the mandated "parity" doesn't bump insurance costs too much or b) eliminate health insurance altogether. No law yet mandates coverage for your business. If you take either step, some staff will quit; some candidates will take other offers. That's an acceptable sacrifice in today's market; resumes will come in from a new ad.

Mental health parity gives businesses a long-sought excuse to slash needed medical coverage for maternity, family member coverage, injuries and verifiable diseases. The mania for this proposed law needs a sedative.

Jon von Gunten


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