In early September, during the election campaign, President Biden and Vice President/Candidate Harris announced a “historic final rule that will ensure mental health care coverage for 175 million Americans is on par with their physical health care coverage.” The announcement received scant attention during the remainder of the campaign. Indeed, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits has been routinely flouted by insurers in the years since its passage. The Biden/Harris “historic final rule” is but the last in a long line of state and federal rulings intended to bring parity to substance use and mental health care.
My awareness of the law came about when my 23-year-old son went to a Manhattan hospital with his bag packed seeking admittance to inpatient detox. He had struggled with substance use for two years, more particularly heroin, benzodiazepines, cannabis, and alcohol. He knew what kind of help he was asking for. It took less than an hour for his insurer to deny him inpatient treatment as “not medically necessary.” Despondent, he left the hospital, returned to our Upper West Side neighborhood, overdosed in a Starbucks bathroom, and was taken by ambulance to a nearby hospital where he was treated and released on the same day, all without our knowledge. He returned home that evening. We knew nothing about the details of his day until after his death due to an accidental overdose four days following his detox request. Six weeks of hospitalization followed before it was undeniably clear that he was consigned to a permanent vegetative state. We made the grievous decision to remove him from life support. His body became an anatomical donation to Columbia University’s College of Physicians and Surgeons.
Though we’d had skirmishes over insurance coverage for our family before, this event brought us to an unhealthy frustration with insurers. I am well aware that a family in Minnesota rightly grieves the loss of their insurance executive husband and father. I am equally aware of the impacted anger of hundreds of thousands, if not millions of families like us who have suffered because of unfavorable insurance reviews and denials. The inhumanity of insurers has created a mental health problem, a revenge-seeking urge that manifests itself in the population insurers purportedly serve. That urge has seemingly lain dormant until it ruptured open with the murder of an insurance executive. That murder has exposed at least some of the toxins that prompted the shooting. The shooter has become a folk hero.
I have not celebrated the murderer’s success, nor do I find him a folk hero in any way, but I do understand the depth of the rage that drove him to act the way he did. His is but the most advanced case of a disease so many of us suffer from. In my quiet fury, I have fantasized about horrible acts. In my case, acts are directed at the lawyers who defend the violations and abuses insurers practice. I have often said that there must be a special Circle in Hell for these insurance lawyers. I haven’t marked bullet casings, but based on personal experience I have frequently employed the words dodge, delay, dissemble, and deny to describe insurance practice. The congruent vocabulary I share with the shooter does not surprise me. “Depose” is a threat insurers use to intimidate, shame, and stigmatize the conditions of those who would challenge a claim denial. A deposition seldom goes the other way. Bringing a case against an insurer requires financial and emotional resources and the stamina to stay the course. Insurers know and count on very few having this combination to achieve a favorable determination. Potential plaintiffs die daily. Insurance companies have time on their side.
What remains to be seen is how this revenge disease develops. Will more who feel aggrieved take up arms or engage in destructive acts? Will it flare up and then flare out? It is and will continue to be a mental health issue. Will it become an epidemic? Where will the leadership come from to help find a cure? Do we as a nation care? Care enough to drive politicians to act? Action that is more than a dying ember in a political campaign? We can’t afford sixteen more years to dither with insurance malpractice while a disease that malpractice spawned becomes an epidemic becomes a plague.
