In Practice

A practicing doctor's views on psychiatry and contemporary culture.

The Bailout’s a Mental Heath Measure – No, Really!

Why the financial bailout's a mental health bill.
When the Senate passed the multi-hundred-billion-dollar bailout, the Emergency Economic Stabilization Act of 2008, you may have wondered: How does that work? The Constitution specifies that "All bills for raising Revenue shall originate in the House of Representatives." Clearly, the proposed act includes revenue measures; its sweeteners restrict the alternative minimum tax and extend exemptions for businesses.

The answer is that the drafters used parliamentary legerdemain. They stuffed the emergency legislation into . . . the Mental Health Parity Act! The Act is a "money bill" that requires insurers to treat mental illness more like other bodily illness. Since the skin of the act had passed in the House, the whole animal became kosher.

If you read its opening, you will find that the bailout bill is now an amendment to the tax code intended to: "require equity in the provision of mental health and substance-related disorder benefits under group health plans, to prohibit discrimination on the basis of genetic information with respect to health insurance and employment, and for other purposes." The lead author is Rhode Island's own Patrick Kennedy, who admirably proposed the parity law but who was not party to the financial deliberations. Some reports have said that the mental health provisions were stripped from the bill, but the truth is that beginning on page 310 of the text and continuing for 35 pages, the "Paul Wellstone and Pete Dominici Mental Health Parity and Equity Act" stands intact. My hope is that the fiction means that, with the help of this quirky piece of good fortune, the parity provisions will pass.

Heaven knows, we could use an injection of mental health into politics these days. Doesn't it seem that the system's gone off the rails?

I know, I know, it's a cheap segue, but with the vice-presidential debates pending, I can't resist a short rant about elites and expertise. I don't know whether the bailout is the best we can do - critics on the left fill this week's Nation with arguments that it's not. But what does it mean when a handful of right-wing ideologues in the House ignore the leading Republican economists - really, most serious economists - and hold the country hostage? Or when our supposedly conservative party chooses as its standard-bearer a gambler (re: casinos and craps tables — "for much of his adult life, Mr. McCain has gambled as often as once a month") who then selects a know-nothing as his back-up?

Famously, Sarah Palin cannot recall a magazine or newspaper she reads or name a recent decision besides Roe v. Wade where an activist Supreme Court overstepped its authority. (Sarah, how about Bush v. Gore?) The one thing she got right, in her famous jumble of non-sequiturs during the Katie Couric interview, is that yes, the bailout does (now) involve (mental) health care insurance. The problem is not simply that Palin is inexperienced, it's that she's incurious.

W has the same disastrous defect. I have not read the latest Bob Woodward book, but reports say that it returns repeatedly to Bush's hostility toward evidence. We all know that the "best and the brightest" can make mistakes, as in Vietnam. But a prudent gambler would bet on expertise and knowledge, at the least as elements in political decisions.

Here's hoping - praying, if an atheist can use that verb - that Palin embarrasses her party tonight. Republicans have earned the humiliation. As for the top of the ticket, what a relief it will be if the electorate can set aside its perverse disdain for competence and choose an outstanding student of constitutional law as President.

Afterword: For a next-day follow-up,see my posting on the insta-polls of the vice-presidential debate. 

 



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Peter D. Kramer is a psychiatrist and author. His books include Against Depression and Listening to Prozac.

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