|By CATHERINE RAMPELL|
There are plenty of days when Eliza can’t manage to get herself out of the house. On others, she can’t even get out of bed. And in between, she often can’t sleep, can’t concentrate and can’t remember things. She definitely can’t hold down a job. At least not right now.
Eliza, who asked that I not disclose her last name, successfully battled depression for most of her life. She persevered through college and graduate school and worked steadily for more than a decade as a pharmacist. Then, about two years ago, she suffered from an unusually debilitating stretch in which she didn’t respond to antidepressants, and her insurance company refused to pay for experimental treatments that her doctors recommended. Now in her 40s, she has become one of the more than 1.4 million Americans on the federal disability rolls for mood disorders. She also receives
Mental illness has been an increasingly significant health concern over the past several decades, but it’s now becoming an economic one too. The number of Americans who receive
Reduced earnings and a lower likelihood of being, or staying, married compound the problem. The mentally ill are at higher risk of poverty than their peers, which subsequently increases their need for other public safety-net services like food stamps and subsidized housing. Their use of those services, according to one recent estimate, probably costs taxpayers another
With a major expansion of health insurance slated to take effect next year under Obamacare, policy makers are obsessing over how to bring down such costs. But listening to Eliza talk about getting back to work, it was hard not to wonder whether the best way to cut the long-term costs associated with mental illness was, paradoxically, to spend more money on directly treating it now. Economists refer to this as the cost offset, and it’s sort of like a return on an investment that comes from helping mentally ill people become more productive and less dependent on taxpayers.
There is evidence that suggests this might work. A study published in 2007 in The Journal of the
The question is whether those findings will apply on a much larger scale. Obamacare — coupled with another recent law that forces insurers to cover behavioral-health care the same way they cover other medical care — will significantly increase coverage for mental illness for about 62.5 million people. And there is one subtle way that this expansion of coverage could improve Americans’ outcomes almost immediately. The recent Oregon Medicaid experiment, in which poor people received
The main way expanded coverage would help people with mental illness, though, would be to get more of them into successful treatment. And Obamacare alone won’t get that done. Even though tens of millions of people will get more coverage, estimates suggest that only 1.15 million new users will take advantage of mental-health services. A lot of people who will be extended coverage don’t need care; others, fearful of the stigma around mental health, may not take it. What’s more distressing, from both an economic and a social perspective, is that a lot of people who do muster the courage still won’t get the right kind of treatment. About half of Americans who seek care for serious mental illnesses get treatment that does not help them or is not even recommended for their condition. Some, like Eliza, have illnesses that are resistant to first-line antidepressants. It took years before she could get her insurance company to foot the bill for an alternate treatment that her doctors said was medically necessary. By then she had already fallen into poverty.
One way to address the quality-of-care issue is to invest in more comparative-effectiveness research, which is a fancy term for pitting health care options head to head to see which works best for which patients and under what circumstances. Economists have long advocated this as a way to ensure we’re spending our money more wisely, but
Deep thoughts this week:
1. Mental illness is costing us hundreds of billions in obvious ways.
2.And hundreds of billions in less obvious ones.
3. We may need to spend money to save money.
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|Source:||New York Times Digital|