The right to assisted living


ALEXANDRIA, Va. -- Along with brown eyes, white skin and a hyperacidic stomach, I have inherited a family history of depression.

This means that I take medication to enable the neurotransmitters in my brain to function more efficiently, just as I take medication to control the amount of acid my digestive system produces. With the help of the former, I am a productive graduate of Harvard Law School who has written a nationally award-winning book on the Bill of Rights; with the help of the latter, I can eat pizza.

But thanks to the current health-insurance system, I am reimbursed for only 50 percent of my psychopharmacologist's fee -- compared to 80 percent for my gastroenterologist. Yet the visits are exactly the same type of service: I see a medical specialist who prescribes and monitors medication.

The difference, according to my insurance company, is "strictly diagnosis." One is classified as a "mental disorder" and the other a "physical condition" -- although both are based in biology.

In April, the U.S. Senate passed legislation to end this type of discrimination, as an amendment to the Kennedy-Kassebaum health-insurance reform bill. The amendment prohibits insurance companies from imposing treatment limits on mental illness that do not also apply to physical disorders. It is currently stalled in Congress, hostage to the fight between the House and the Senate over medical savings accounts.

Political odd couple

The amendment's co-payments, Sens. Pete Domenici, R-N.M., and Paul Wellstone, D-Minn., are a political odd couple who share a family experience with mental illness. Mr. Domenici's daughter is schizophrenic; the hospital bills for Mr. Wellstone's older brother almost bankrupted his family.

But, as the senators point out, the mental-health parity amendment is about more than just economics. It eliminates a distinction based on prejudice, not science, like so many others that Congress has addressed: race, gender, nationality and religion. It rescues millions of Americans like me from the back of the medical bus.

But critics of the measure, among them the Business Roundtable, say we should wait for another chance -- just as white ministers urged Martin Luther King to be patient. They propose a federal commission to study the problem further.

Parity in five states

But there is plenty of statistical evidence to demonstrate the cost effectiveness of adequate mental-health coverage. Five states -- and such major corporations as Hewlett-Packard and IBM -- have already implemented some version of mental-health parity. What is needed is political will, not more study.

In response to cost concerns, Senators Domenici and Wellstone have offered a compromise that would require parity of coverage for mental illness regarding lifetime caps or annual limits, but not deductibles or co-sponsors.

Even with these restrictions, the measure represents a significant advance toward equal treatment for people with biological disorders of the brain (a.k.a. "mental illness") -- a condition more common than cancer, diabetes or heart disease.

Yet even some champions of the mentally ill have been slow to endorse the Domenici-Wellstone amendment, most notably Sen. Ted Kennedy. As a sponsor of the Senate's overall health-reform bill, he took a "no amendments" strategy to secure its passage by both houses of Congress.

A similar predicament faced supporters of Title VII of the Civil Rights Act of 1964, which outlawed job discrimination based on race. At the last minute, opponents of the bill offered an amendment to prohibit gender discrimination, hoping thereby to scuttle the legislation altogether.

But advocates for women's rights rallied at an unexpected opportunity 30 years ago, and in so doing dramatically changed the American workplace for the better. For those of us who are labeled with "mental disorders," the Domenici-Wellstone amendment is just such a watershed in history. Now is the time for our allies to be counted, and there can be no procedural excuses. We need every vote.

"Coming out"

I write this article in fear of the repercussions of "coming out" about my condition. In addition to risking social stigma, I also must surrender my medical privacy in order to fight an unjust system. Like any form of discrimination, the current health-insurance system depends on its victims to keep quiet. Congress can end that conspiracy of silence.

Yes, the legislation will have certain costs. So did abolishing segregated schools. But it is no solution to rising health-care costs to scapegoat millions of Americans desperately in need of medical services.

Mental illness has life-or-death consequences. At a time when the right du jour is assisted dying, how about protecting the right to assisted living?

Linda R. Monk is the author of "The Bill of Rights: A User's Guide," which won the American Bar Association's Gavel Award.

Pub Date: 7/11/96

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