Beyond My Ken

Post on May 17, 2007 by Andrea Verykoukis 13 Comments »

Ken Eudy came to see me yesterday, upset by my last post . He felt it was too rough. In the interest of fairness, I will pass on his thoughts. His last effort to defeat parity was in 1998. (That's also the last time I wore a size 6, but I remember it fondly as the not-too-distant past.) The bill was rushed through the Senate and, according to Ken would have allowed an addict to attend 28-day rehab programs 12 times in a calendar year. The reasons weren't as compelling as the chicken enchiladas that were cooling on my table. (Did I mention it was dinnertime?) Anyway, he personally supports mental health parity and hasn't discussed it with Blue Cross since they killed it in '98. Finally, he does no lobbying for Blue Cross at this time. So, I'm passing that on in fairness to Ken Eudy.

My point, in my previous post and in my conversation last night, is that I am here to show people what's going in state politics. Not as someone who's at the legislature everyday, but as someone who's more interested in politics than some and who pays attention to and connects the news that's widely available. An armchair observer or a gal on the street, if you will. Ken Eudy is a force in Democratic politics in North Carolina who is also working to keep BCBS smelling like roses as they defeat things like mental health parity. I stand by that assessment, and I enjoy writing for this blog. I hope this clears the air.

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Affordable Coverage for Everyone v. Wealthy Special Interests

Ken Eudy and Blue Cross

Comments (Closed):12

Adam Searing
May 17, 2007 at 9:34 am
Andrea, I think your original assessment is right on. BCBS spends millions with Capstrat to improve its image and help it continue to have the power it does in the GA. I’m sorry Ken was upset, but as someone who has watched his efforts on behalf of BCBS for years, I don’t think he has much to be upset about.
sturner
May 17, 2007 at 10:39 am
This is where the obscene profits (or “surplus” as Rob would say) for BCBS become awkward. As most of us know, BCBS cleared $190 million in profit in 2006, which was $6 million less than in their record year of 2003 (http://www.newsobserver.com/business/story/574903.html )

Does anyone know what the cost estimates are to implement mental health parity? I know in the long-run there are cost savings, but what direct costs would there be to BCBS if parity were immediately implemented?
Jetmars
May 17, 2007 at 1:37 pm
You rock girl…keep it up “gal on the street” observer and awesome lady! You have style (and are still a size six) and strong points. Keep it up.
Andrea V
May 17, 2007 at 1:38 pm
Actually, M.R., Eudy did not tell me I had anything wrong. I didn’t say he’s involved in the current effort to defeat parity and he didn’t deny that he was involved in such efforts in the past. He was just upset that I wrote about something that he considers old news. To me the fact that he helped defeat parity nine years ago just means that there have been nine years when the mentally ill have been denied decent benefits because of his efforts. If that’s offensive, it’s not my fault.

There’s no question about causation here, either. BCBS lobbyists are fighting the bill as it came out of the Health Committee. Let me also point out that these efforts are simply to offer people decent plans that they will pay for. No one’s asking for anything free or doing any “sanctimonious whining” that I can tell.

As for a workable deal, I quote Rob’s original piece: “[F]ull parity cost Marylanders a 0.6% hike in costs. In Minnesota, the cost was comparable. Best estimates from actuaries and experience in the federal employee system (where parity has long been the law) point to a similar bump in North Carolina. Many analysts believe (and common sense confirms) that parity can produce lower overall medical costs.” Won’t this help everyone, including businesses? How is this not workable?
Adam Searing
May 17, 2007 at 1:49 pm
Well, well – maybe I can expect a visit at my house from “Middle Road” like Andrea got from Ken at dinnertime last night. As to longtime links between Eudy and Blue Cross, look no further than his personal lobbying registrations for the last ten years:

http://www.secretary.state.nc.us/lobbyists/Lobbyist.aspx?PId=8059904

And remember – those millions Blue is paying to Capstrat to pump up their image is money from the pockets of millions of North Carolinians who are paying higher insurance premiums to finance stuff like that. Not what I want my health dollar going for – but maybe some do.

Adam
sturner
May 17, 2007 at 10:03 pm
M.Road
I find it interesting that you consider substance abuse a “dubious malady” and note that it’s treatment is “anathema to the business community.” Why is that? The fact that you can even write a sentence like that should give all the “parity proponents” enough validation to keep on fighting.

Apparently you feel like substance abuse is not a biologically-based “real illness.” Are you aware of the significance of genetic predisposition in substance abuse? Children of alcoholic parents are four times more likely to become alcoholic themselves. Furthermore, there is a high degree of concurrence between substance abuse and mental illness (particularly bipolar disorder). What does it say about us as a society that we somehow want to blame people for their mental illness?

We stigmatize mental illness (and I will include substance abuse in this as well) by the mere fact that we carve it out separately from every other illness. Why do we have a separate mental health services phone number on our insurance card? Clearly because of the genetic component to mental illness, it is as much of an “organic” disease as diabetes. Think about it. These folks are stigmatized because researchers do not yet understand the brain neurotransmitters as well as they understand the islet cells in the pancreas. This is a failure of science. We ought not let the social contract fail them, too.

If we concede that mental illness is an organic disease with a genetic basis, why is it OK to let the employer offer (or not) a menu of partial mental health services? Because it’s too expensive? If that’s the way business wants to play the game, then I would think it would be their fiduciary responsibility to refuse smoking employees treatment for emphysema, heart disease, or stroke. Healthcare costs and lost productivity due to smoking surpass losses due to substance abuse, mental illness, or any other disorder.

Bottom line: we need to stop trying to figure out which diseases are more worthy of treatment than others.
Andrea V
May 18, 2007 at 7:32 am
Steve has responded before I could, and better than I could, for sure. Separating substance abuse and mental health is absurd not only because they’re all “biologically based brain diseases” (inasmuch as that means anything) that need special treatment. How does it behoove the business community to refuse their valued employees treatment when they’re suffering. Plenty of people, from bus drivers to doctors, seek treatment every year. Can the business community get along without them? Furthermore, look at the rates of dual diagnosis, especially among the depressed, the bipolar, and the schizophrenic, which according to MR are somehow acceptable diseases. For many patients, you simply cannot treat the mental illness without treating the substance abuse and vice versa. Any compromise that included splitting the two would be useless. Compromising on this isn’t “boneheaded” it’s perfectly sensible. For more you can Google dual diagnosis, or look here:
http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049
mid rd
May 18, 2007 at 8:54 am
For those of you who are confused by responses to a non-existent post, please be advised Adam has not only blocked me from posting, but removed all my prior posts.

Apparently this is not a discussion forum, but only a soapbox for Adam to present one-sided, poorly researched, often illogical points of view.
untouchable
May 18, 2007 at 9:36 am
I hope you read my response quickly, before Adam has me erased for “non-agreement” (perhaps “Progressive Pulse” is no longer a good name for this forum. I suggest “Yes, Adam, you’re right again.”)

I never said that substance abuse was a dubious malady. I have a long family history of substance abuse, and believe me, it’s real. It’s also the root cause for vast amounts of social ills. I would also agree that mental illness and substance abuse are very intertwined.

My point was that most of the earlier parity bills included coverage for some dubious stuff. Read the Diagnostic Manual some time; you’ll be amazed at what common human problems are defined as “mental illness.”

My read on what concerns the business community about substance abuse: 1) substance abuse treatment varies considerably in quality and they may be forced to pay for treatment this isn’t very effective; 2) the potential cost of treating not just employees, but dependents of employees could be considerable and they’re already concerned about cost; 3) for some business owners, the sense that they should be able to fire employees who drink, are violent or abusive (or all three).

I disagree that compromising would be useless. The reality of politics is that it often takes multiple sessions to get something big done. Getting coverage for thousand of schizophrenics and depressives would have real value, and it would help remove the stigma about treating mental illness. People can be helped; and their stories would provide pretty compelling testimony for pushing the envelope further.

The other thing that would help is for the mental health community to improve the consistency of treatment and do a better job of documenting “best practices.” All this would raise confidence in the cost-effectiveness of behavioral care.
old social worker
May 18, 2007 at 12:44 pm
The mental health community has, from Hippocrates to Charcot to Bleuler to Freud to Menninger to Yalom to Linehan and all their backers, comrades, and minions, done a fine job of defining and refining the most effective treatments. You may read about them, if you care, in any library or bookstore.

Consistently providing those treatmentrs, however, has too often cycled with political and economic fads, much to the detriment of clients and patients. Once we resolve who’s going to pay the freight, we can focus on delivering quality treatment.

As for the false dichotomy between physical and mental health, I have to agree with the eminent historian Jacques Barzun, who noted that he never encountered a brain that existed outside of a body.
sturner
May 18, 2007 at 1:30 pm
M. Road,
I appreciate your reasonable response.

A few quick takes: You are correct that the DSM has gray areas of interpretation for whether certain behaviors are pathologic or not. Famous examples are Premenstrual Dysphoric Disorder (PMS), Social Phobic Disorder (shy), Dysthymia (brooding), etc. To be clear, though, these are red herrings which divert from the central issue. I doubt treatment for these types of diagnoses make up more than 1% of any mental health budget predictions.

Also, I think you are still somewhat unfairly singling out substance abuse treatment. All disorders have treatment options that may not be optimal in quality or effectiveness. Americans spend over 100 billion dollars annually treating back pain, much of it useless.

We completely agree that there should be an emphasis on “best practices,” but not just for the mental health practitioners. Every medical specialty needs to do more here. As an aside, the government should increase funding significantly so that we have unbiased (i.e. non-big Pharma) studies so we actually know what the “best practices” are. The best recent example of this was the Women’s Health Initiative on hormone replacement therapy which showed an increase in breast cancer, heart disease, and stroke with HRT. The dramatic decrease we have seen in breast cancer cases in the last two years may be due to the results of this study.

Finally, politics is the art of compromise, I guess. It just seems that the mental health community has made alot of concessions along the way. If I were a “parity proponent” I would be pushing hard for…well…parity. It seems ethically just and financially feasible.
adamlexi
June 21, 2008 at 5:33 am
Progressive pulse is a site which contain all about human mental pulses.Now a days so many people doing hard work and they effected by th4eir jobwork. A human body is tired it means he wants some rest but the mind is depressed he can not do any kind of work wheather it is a body work or a mind work/

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adam
Dual Diagnosis
http://www.dual-diagnosis.net