A recent Report of the Financing, Utilization and Quality of Mental Health Care in the United States (April 1976, Office of Program Development and Analysis, NIMH) provides the most detailed information available on this topic. This report indicates clearly that mental illness is insurable and should be covered on an equal basis with other illness under any plan of National Health Insurance.
Insurance carriers, however, have been attempting to limit coverage for mental illness in health insurance plans. The Blue CrossBlue Shield have been threatining to change the benefits in the Federal employees program. Insurance carriers have been concerned about the increasing cost of insuring mental illness. We are frequently reminded that in the Federal Employees Health Plan, a small number of patients (1%) are using a larger proportion of the mental health dollars (about 10%) for long term intensive psychotherapy and psychoanalysis.
The carriers are also disturbed by a number of problems: the difficulty in obtaining information for claims review, uncertainty in diagnosis, lack of clarity about treatment criteria for any particular diagnostic category, differing modalities of treatment for the same diagnostic condition, and competitive differences between mental health professionals. Legislators are also confused by the differing opinions and different information offered to them. There is no consistent, organized presentation of the views of the American Psychoanalytic Association to the Congress. Various members of our organization, including members of the Committee on Legislative review have worked with committees of other organizations (such as the American Psychiatric Association) on specific issues.
At a conference on “The Crisis in Psychiatric Care and Insurance Coverage” in Washington June 11-12, 1976, sponsored by Congressman James Scheuer (D.N.Y.) and the American Association for Social Psychiatry, Rep. Scheuer said that mental health professionals have not gotten the message across to the congress about the great need in this country for their services.
Gov. Carter has pledged National Insurance Legislation if he is elected President. Many legislators are in favor of some national health legislation. It is clear that there will be activity in this direction in the next session of Congress. What the plans and priorities might be by a Carter administration are still unclear. From the experience in Georgia, and the interests and statements made by Carter's close advisors on health and mental health policy, a good guess is that the main thrust will be to increase support for Community Mental Health Centers. Whether private psychiatric care will be supported on a fee-for-service basis by insurance coverage or whether the entire medical system will be changed is uncertain.
At the Annual Meeting of the American Psychoanalytic Association in Baltimore in May of this year, a resolution was passed by the Presidents and Presidents-elect of Affiliate Societies to request the Executive Committee 1) to reconsider the report of Dr. Babcock's Feasability Committee for employment of a Legislative Affairs Coordinator in Washington, and 2) to obtain legal guidance for possible formation of a Political Action Committee to raise funds to engage the services of such a professional lobbyist in Washington. The Executive Committee asked the Committee on Legislative Review to obtain information from the Affiliates Societies concerning the degree of approval and financial support from voluntary contributions that might be expected from the membership and candidates. The Executive Committee also requested the Chairman to obtain information about the cost of such services.
—William L. Granatir