Wednesday, April 18, 2007

"Three Generations of Imbeciles is Enough"

Texas ranks 47th in per capita spending on mental health care. Texas is #1 in state executions, by a margin no other state even approaches. It is impossible to say any longer that these two are not connected:

Very few people on death row are entirely rational. Many suffer from some form of mental illness."
Ted Cruz, Solicitor General, State of Texas.

Which seems, on the surface, bad enough. But it goes down; really deep down:

“Parity” refers to the effort to treat mental health financing on the same basis as financing for general health services. In recent years advocates have repeatedly tried to expand mental health coverage—in the face of cost-containment policies that have been widespread since the 1980s. Parity legislation is an effort to address at once both the adverse selection problem and the fairness problem associated with moral hazard. The fundamental motivation behind parity legislation is the desire to cover mental illness on the same basis as somatic illness, that is, to cover mental illness fairly. A parity mandate requires all insurers in a market to offer the same coverage, equivalent to the coverage for all other disorders. The potential ability of managed care to control costs (through utilization management of moral hazard) without limiting benefits makes a parity mandate more affordable than under a fee-for-service system.

Managed care coupled with parity laws offers opportunities for focused cost control by eliminating moral hazard without unfairly restricting coverage through arbitrary limits or cost-sharing and by controlling adverse selection. However, continued use of unnecessary limits or overly aggressive management may lead to undertreatment or to restricted access to services and plans.


State efforts at parity legislation paralleled those at the Federal level. During the past decade, a growing number of states have implemented parity (Hennessy & Stephens, 1997; National Advisory Mental Health Council, 1998; SAMHSA, 1999). Some (e.g., Texas) target their parity legislation narrowly to include only people with severe mental disorders; others use a broader definition of mental illness for parity coverage (e.g., Maryland) and include, in some cases, substance abuse. Some states (e.g., Maryland) focus on a broad range of insured populations; others focus only on a single population (e.g., Texas state employees) (National Alliance for the Mentally Ill, 1999).
"Mental Health: A Report of the Surgeon General"

Either Texas isn't interested in parity, or, as the Texas Solicitor General is going to argue in Panetti v. Quarterman, people who don't have severe mental disorders don't qualify for mental health care, but do qualify to be executed, because they're crazy enough to be criminals.

Good grief.

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