'Parity' isn't free


CHICAGO - In announcing his new position on insurance for mental illness, President Bush struck a pose reminiscent of Balboa gazing out for the first time at the Pacific Ocean, seeing something that others have not.

"Mental illness," he announced, "is not a scandal; it is an illness. And like physical illness, it is treatable." He went on to bravely warn against stigmatizing the mentally ill, because "stigma leads to isolation."

Across the country, people were slapping their foreheads and exclaiming, "Of course! Why didn't that occur to me?"

The president wants to force health care providers to furnish broader and more expensive mental health coverage than they are currently doing. The point of his remarks was to depict opposition to his idea as evidence of ignorance or prejudice against the mentally ill.

You'll be glad to know that, in fact, no one is opposing the administration's initiative on the grounds that the mentally ill should be mercilessly shamed rather than treated. The opposition comes from the principle - which I seem to remember Mr. Bush endorsing once or twice - that the government generally shouldn't overrule the voluntary decisions of competent individuals in the private sector, but ought to rely on markets to maximize happiness and well-being.

Never mind his party affiliation. On this issue, Mr. Bush sounds like an old-fashioned Democrat, acting as though a pure heart is all you need to understand the wisdom of a bigger government role.

It's fun to give people what they deserve if you don't have to pay for it. Many people run for office so they can play Santa Claus year-round with someone else's money. Regrettably, someone does have to bear the cost of more generous health insurance. The Bush plan is vintage Bill Clinton: Give Washington the credit for doing good, but send the private sector the bill, and let someone else worry about the consequences.

Mr. Bush hasn't spelled out all the details of his approach, but the White House said his goal is "maximum parity" between coverage for mental and physical illnesses. The chief bill on Capitol Hill would compel equal coverage for all mental illnesses. Mr. Bush may not go that far, but he apparently will demand equal insurance at least for the most serious disorders.

Supporters of the tougher mandates assure us that the cost will be trivial - increasing current premiums by no more than 1 percent. But that still amounts to some $23 billion a year, and if there is any iron law in Washington, it's that health care always ends up costing more than we are told by the politicians who approve it.

What the advocates fail to explain is why American businesses would refuse to provide something that is so cheap and yet so valuable. Employers don't have to provide any health insurance at all, and those that do are not acting entirely out of the kindness of their hearts. Most do it because they have to compete to attract and keep good workers. If mental health coverage were something treasured by employees and easy to afford, you can be sure that businesses would be knocking each other down to provide it.

In fact, companies are not only declining to offer such broad coverage but resisting congressional efforts to force it down their throats. That suggests they don't believe mental health "parity" is quite the free lunch it pretends to be.

Of course, employers will find ways to cope with the new mandate if they have to. One way is to cut back on other benefits that their workers value more. Another is to drop health insurance entirely.

One of the main reasons 38 million Americans lack health insurance is that Congress and state legislatures have forced insurers to provide all sorts of coverage that many customers don't want. These mandates drive up premiums, which makes insurance unaffordable for some people, leaving them without coverage for mental or physical illness. That's a sort of parity, I guess.

It's a fantasy to think the federal government can hand out favors to voters without also imposing burdens on those same voters. But when this delusion grips our leaders, it's probably not treatable.

Steve Chapman is a columnist for the Chicago Tribune, a Tribune Publishing newspaper. His column appears Tuesdays in The Sun.

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