Something that we can promote.
I was reading calistan's diary http://www.dailykos.com/story/2005/3/31/112714/038 earlier today which makes the point about the lost lesson of Terri.
Although mentioned in a peripheral way, little emphasis has been placed on the inital cause of Terri's condition, a disease called bulimia nervosa. I have actually been somewhat surprised by this, at least in the sense that mental health experts (excepting myself, who I talk to a lot) have been silent on this.
Yet, this is one of those areas in which the Democrats can point to Terri's situation in a positive way, and use this tragedy, once the main stream noise machine has quieted down. How so?
Insurance.
Bulimia nervosa is the most well known form of bulimia. It is evidenced by a cycle of binge eating, followed by self-induced vomiting called purging. The chemical system of the body is put out of balance by this and in severe cases can result in heart attacks, as well as other severe medical complications.
Unlike anorexia, which is straight restriction of food intake, frequently accompanied by rigorous exercise, the bulimic does not necessarily look ill as there is not necessarily a significant weight loss, although in Terri's case it appears there was.
The reason for the malpractice suit that Michael initiated was that terri was being seen by doctors for other reasons, and it was determined that they should have recognized Terri's condition and recommended specialized treatment for her eating disorder.
It should be noted that such treatment can be very lengthy, intense and expensive. And that is where the subject of this diary comes into play.
If Terri entered treatment for her eating disorder, how would it have been paid? I do not know what type of health insurance Terri and Michael had or the benefits it offered, but reality is that many people in Terri's condition do not have sufficient coverage.
You see, an eating disorder falls under mental health benefits, not medical. Although Congress several years ago passed a mental health parity act, it was somewhat of a joke. To understand, a brief history of mental health insurance is needed.
Up until the 1970's, virtually all mental health treatment was reimbursed the same as any other type of medical treatment. Unfortunately, some providers, specially adolescent treatment centers would tend to keep patients until all their benefits ran out. And we are talking about lifetime benefits.
Needless to say, this resulted in some major revisions by insurance companies with two primary consequences. The first was managed care, where the providers of treatment had to justify that the care they were providing was medically necessary.
The second, and most important, was the placement of dollar limits on mental health care. It was not uncommon to see a policy which allowed a total of $10,000 coverage for a mental health treatment.
It bacame obvious, after a period of time, that for many people with severe mental disorders, this would not be sufficient, and many attempts were made to have Congress require full parity in coverage. What Congress finally did do was say that if mental health coverage was provided, there could not be dollar limits on that coverage.
Great? Not so fast. What they did allow were day limits and visit limits. Many policies therefore had limits of 10 to 30 days per year for inpatient care, and limits of 20 outpatient visits for counseling. Some were even worse.
Fortunately, some states have passed legislation that requires full parity, without limits, for what are considered biologically based mental health diagnoses such as depression, bipolar disorder, autism etc. A few states include eating disorders in that grouping.
However, these requirements only cover about 1/2 of all insured people, as many employers fall into what is called self-insured employers and do not have to comply with state guidelines.
How does all this tie into Terri's case?
Simply this. It is possible that she would not have been able to afford treatment for an eating disorder. And there are thousands of people out there that face the same situation.
The Dems can and should produce legislation calling for full mental health parity, without day or visit limitations. And they can point out that the tragedy of Terri Schiavo does not need to be repeated because someone was unable to afford care even though they had insurance.
Because, beleive me, it has happened in the past and will happen again unless action is taken.