Better than Ezra.

Despite promises of a self-proclaimed whippersnapper wonk, reality sometimes has a way of saying, "Thanks, but no thanks."

Still, cute lil fella that he is ("Watch me on Rachel Maddow tonight everyone!"), Ezra predicts the majority will just forget about this massive entitlement expansion.*

Cute, but a little dumb, if you ask me...

For example, here's one (predicted) effect of that mental health parity bill that passed under the late Sen. Kennedy's (well meaning) auspices a year ago:

Woodman’s Food Market, the giant grocery retailer, is dropping mental health benefits from its health insurance plan because it claims it can not afford to comply with a new federal law that will require mental health coverage to be equal to benefits for other illnesses.

The federal mental health parity law, passed in 2008, takes effect this January. The law does not require companies to offer mental health benefits, but if their health plans do offer mental health coverage, it must be as generous as coverage for other diseases. Critics of the bill, including many businesses, had warned that it would backfire by forcing companies to drop what limited mental health benefits they do offer.

"We have one of the best health plans in Wisconsin, and we can’t open up our employee-owners to a bunch of unidentified costs. We can’t have an open checkbook," says Clint Woodman, a vice president at the company and the grandson of Bill Woodman, who opened the first food store in Janesville in 1930. Today the chain includes 12 stores, 9 in Wisconsin and two of them in Madison, and employs over 2,800 workers, around half of whom also own a stake in the company.

Representatives for workers and local mental health advocates were quick to respond to the news, organizing a press conference for Tuesday afternoon at 1 p.m. at the Gammon St. entrance to the west side Woodman’s parking lot. "It’s very important to address this issue head on," says William Greer, the CEO and president of the Dane County Mental Health Center. "This is a precedent that I’m very concerned about. I’m worried other employers could follow suit. My hope is that any employer who is worried about this will give mental health parity a try before canceling."

I wonder how many hours of psychological help equal one MRI, helicopter lift, or surgery. That's a mighty high ceiling, where there is one.
Mandates = no good for BUSINESSSES. (but I guess you'd have to have a few years of actual non-wonk employment under your belt to understand how the real world works and all...)
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* A year after the president signs health-care reform, the country will have largely forgotten about it. That's not to say it won't be mentioned in the elections, or argued over in occasional op-eds. But what keeps it on the front page? It's easy enough to write about health-care reform when it's dominating the congressional agenda. When it's waiting to be implemented? Or when it's being implemented, and the main effect is that 16 million people without political power now have health-care coverage? I don't buy it.

The working theory appears to be that voters will blame Congress for the yearly increases in insurance premiums that will happen anyway. Again, I don't buy it. Most people don't see those increases. If they did, this would be a very different conversation. Health-care reform is very big on the scale of things that Congress normally does, but very small in comparison to our health-care system, or even our health-care problem. This bill isn't as good a bill as it needs to be, in large part because it leaves so much of a broken system untouched. But by the same token, it is not as vulnerable a bill as it could be, because it leave so much of a politically powerful system untouched. The political system will move onto other things, and the underlying policy isn't dramatic enough to hold America's attention.

Time will tell, time will tell...

Ezra's betting on short-attention spans dominating.

But as more and more Americans wise up that the good times are over, I'm guessing those youthful attitudes -- many on display from Boomer holdovers blessed by good timing -- peter out, and the country as a whole begins to sober up.

And we all learn to stand up straight, carry our own weight, cuz those tears are going nowhere, baby...

"Don't say that later will be better, now you're stuck in a moment and you can't get out of it..."

Besides, that whole mandate thing? Unconstitutional. But I suspect he thinks folks will forget about that old document too.

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One, Two ... We Want More!

Not a hockey chant, just the liberals arguing that an extension of healthcare benefits to childless adults under the state's BadgerCorePlus program ... might not be enough for the Wellstone-Domenici Mental Health Parity Act.

The Core plan, which opened this year to 50,000 low-income adults, pays for unlimited visits to psychiatrists and for medicine. However, it does not cover treatment from counselors, psychologists, therapists, social workers, addiction experts or other providers of mental health and addiction services, even though many experts consider these services essential to recovery. Nor does it reimburse inpatient hospitalization for mental health and addiction problems, though such hospitalization is covered for other disorders.

Advocates for the mentally ill say these disparities and limitations violate both the federal law state officials support and common sense. Research shows that paying for mental health and addiction treatment can actually reduce future medical costs. Advocates also say the state needs to practice what it preaches. “This is pure hypocrisy,” says Diane Greenley, an attorney with Disability Rights Wisconsin in Madison and a staff member of the Wisconsin Council on Mental Health.

But officials with the state say the costs of expanding coverage are prohibitive and that they are waiting to hear from the Centers for Medicare & Medicaid Services, which is expected to issue guidelines in January on this issue. “The devil is in the details,” says Barbara Beckert, director of the Milwaukee office of Disability Rights Wisconsin, who predicts that advocates and state officials might even be able to work out a compromise before then.
...
Across the state businesses are already scrambling to comply with the new mandate, which kicks in Jan. 1. So is at least one branch of state government, the Department of Employee Trust Funds, which administers group health plans for 236,000 state worker and retirees. The ETF recently notified members in a handbook that coverage for mental health and substance abuse treatment would expand due to the federal parity law. Policies can no longer cap mental health payments and must include coverage for substance abuse as well.

But the state’s BadgerCare Plus Core plan has not made similar changes to its coverage. Officials with the program claim they do not need to.

The department e-mailed a statement to The Capital Times saying that the Core Plan does not violate the federal parity law because it provides unlimited visits to a psychiatrist. “The parity law does not require plans that provide [mental health and substance abuse disorder] benefits to provide access to all services for those conditions,” wrote spokeswoman Stephanie Smiley, who asserted that the program is under no obligation to provide other mental health or substance abuse services or disorders.

But advocates strongly disagree for several reasons. First, they say, limiting treatment to psychiatrists — who, unlike psychologists and other counselors, have a medical degree and can write prescriptions — is an illegal treatment limitation not imposed on other medical conditions in the plan. Second, many psychiatrists, loathe to accept Medicaid rates, refuse to take on these patients. The few that do are often so booked that it takes weeks and even months to see them, particularly in rural and inner city areas. Third, some psychiatrists require patients to be screened first, or seen later by other mental health professionals not covered by the plan. Finally, effective, efficient, and often less expensive therapy is available from psychologists, social workers, therapists, and others not covered by the plan.

“The law says that if you offer mental health benefits there can be no artificial constraints,” says David Riemer, policy director for Community Advocates Public Policy Institute, a Milwaukee organization that provides services and advocacy to low-income people. “On the health side, if you go to a doctor you can get a referral to a rehab specialist. So on the addiction side, if you go to a psychiatrist, you should be able to get a referral to an addictions rehab specialist.”

More with the "should be able to get" talk, no common sense on how this stuff plays out in the real world though.

Maybe if there were a few "artificial constraints" enacted in the first place, their would be less of a need for referral to an "addictions rehab specialist"... or,

If wishes were horses, beggars would ride.

I hope they learn something from Woodman's business decision, but I doubt it.

The need to save money is at the crux of the problem, says Jason Helgerson, program director for the state Medicaid programs. The state deserves credit, not criticism, for getting the core program up and running in this economy, he says. The state would like to be able to provide more mental health and substance abuse benefits to members. But it can’t afford to do so, unless it shrinks some other aspect of the program.

The Core program is a Medicaid waiver program that must remain budget neutral, which means that it can’t exceed a $215 million two-year spending cap imposed by Uncle Sam (the state’s other BadgerCare programs are not run as Medicaid waiver programs with strict caps). Within months of its official debut last summer, the program was so flooded by desperate applicants that it needed to freeze enrollment at 50,000 and start a waiting list, which now numbers more than 20,000.
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The biggest chunk of drug costs, for example, was consumed by anti-psychotic medications. Drugs for such conditions as manic depression, schizophrenia, and bi-polar disorder cost nearly $500,000, or a third of all drug expenditures. And substance abuse, according to state data, racked up the highest costs among claims for in-patient care. More than $155,000 was paid to 35 members going through detox treatment, which is considered medical, not mental health treatment.

State officials found that the one percent of members accounted for approximately 25 percent of the program’s total expenditures in the first three months of its operation, while ten percent of members accounted for around 68 percent of total expenditures. These are at-risk individuals, officials say, with a complex tangle of chronic mental and physical disorders.

Health department officials say they simply cannot afford to pay for even more generous mental health benefits. A state analysis of what it would cost to expand mental health benefits in the Core plan, presented to an advisory group last August, came up with a price tag between $10 and $30 million.