Jewish World Review April 12, 2002 / Rosh Chodesh Iyar, 5762

Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
JWR's Pundits
World Editorial
Cartoon Showcase

Mallard Fillmore

Michael Barone
Mona Charen
Linda Chavez
Ann Coulter
Greg Crosby
Larry Elder
Don Feder
Suzanne Fields
James Glassman
Paul Greenberg
Bob Greene
Betsy Hart
Nat Hentoff
David Horowitz
Marianne Jennings
Michael Kelly
Mort Kondracke
Ch. Krauthammer
Lawrence Kudlow
Dr. Laura
John Leo
Michelle Malkin
Jackie Mason
Chris Matthews
Michael Medved
Kathleen Parker
Wes Pruden
Sam Schulman
Amity Shlaes
Roger Simon
Tony Snow
Thomas Sowell
Cal Thomas
Jonathan S. Tobin
Ben Wattenberg
George Will
Bruce Williams
Walter Williams
Mort Zuckerman

Consumer Reports

Insure the 'crazies'? | Sometime toward the end of the last millennium, we Americans developed a curious notion. Everything that's good should be a right. We forgot that how we manufacture and provide these endless new "rights" can be just as important as the rights themselves.

Several weeks ago, the Medicine Men column dealt with the issue of "parity" for mental health in health-insurance coverage (" Too many beautiful minds to waste") The column reported that "some states have begun to require that mental health treatment be covered in the same way as other medical care." In contrast to that article, which expressed mainly Dr. Glueck's viewpoint, today's column expresses an alternate opinion from Dr. Cihak.

As used here, "parity" is the idea that insurance companies be required to provide coverage for some mental problems to the same degree they provide coverage for physical problems. In other political contexts, "parity" conjures up images of that wasteful world of farm price supports, where production of certain goods is subsidized one year and penalized the next. Yet who, save the scroogiest of Scrooges, could possibly object to keeping family farms together -- or, in the present instance, helping out people with mental illness?

We need to review a few of the problems encountered or created by mandates and subsidies. We'll look at three kinds: historical, personal, and political.

First, there's only a rough medical consensus, and no social or political agreement, on what mental illness is or how it should be defined, much less treated. The census of 1840 was the first to try to count America's crazies. It enumerated just two categories: alcoholism and dementia. The latest edition of the Diagnostic and Statistical Manual put out by the American Psychiatric Association lists over 400 separate ways to go bonkers. More are forthcoming. In a world where, the shrinks assure us, everybody's got some sort of dysfunction, shall they all be covered? For how long? And who decides?

Yes, many of the most severe and debilitating mental illnesses have been shown to be chemically based. I'm willing to believe that some kinds of therapy and treatment do immense good for many such patients, and for others less savagely afflicted, too. But at what point does a passing spell of the blues segue into mental illness, or mere ineptitude, laziness, or cowardice into "dysfunction"? Who is to say? And who is to pay?

Mandating parity also hurts others. Some people lobbying for mental-health parity have family members suffering from mental disorders. Their individual situations may be difficult, even tragic. But in essence they're demanding that the government coerce others into paying for their misfortunes. As a result, those other families will have fewer resources left to deal with their own problems and might not be able to afford their own health insurance.

Even if a relatively benign program to benefit mental-illness sufferers were instituted, it would still be true that almost all government programs have unfortunate consequences in time. Medicare was touted as a way to help older Americans get health care. It has turned into more of an obstacle than a help, as demand spirals out of control and government gradually imposes more and more regulations and restrictions, to the point where some doctors, instead of being paid for their work, are forced to provide services and essentially become slaves to the system.

To paraphrase the comments of a psychiatrist friend: "We psychiatrists have spent years trying to help our patients become independent. Now the government wants us all to become dependent."

So who might object to enforced mental-health parity? Everyone who understands these facts of life. But what's the alternative?

Perhaps this.

By definition, insurance is the pooling of similar risk. It is not, as politicians like to misinterpret it, prepayment of a specified amount in return for unlimited services. True insurance pools are formed when people pay relatively small amounts against the possibility of an uncommon and unpredictable event in the future. You don't buy boat insurance if you don't own a boat, and you know what you'd say to your nautical neighbor if he demanded that you do so in order to help him out. Why then, for example, if you're older than 60, should you subsidize somebody else's contraceptives or pregnancies or abortions? The "reason" is that all those services are bundled together into packages you, your employer, or your politician buys on what is, pretty much, a take-it-or-leave-it basis.

The solution is not more bundling and packaging, and certainly not more governmental coercion and regulation. It's the creation of specialized insurance pools and service- prepayment plans for those who wish to insure against the possibility that they might suffer mental illness.

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2002 Griffin Internet Syndicate, For newspaper or individual subscriptions and reprinting policies, contact: or 1-800-493-4908.