Some years ago, my son Pete begged me for a new bicycle. I demurred, deferred, and delayed all I could before driving with him to the bike shop. After a half hour, I was relieved to find that Pete was as stunned as I was by the price tags. So, with some disappointment, he led me to the shop's exit. But as the door opened, Pete's eyes fell on a row of used bicycles-all trade-ins from those willing to pay big for the perfect cycle.
He paused. Then, with a narrowed, knowing gaze, he walked slowly down the row, finally placing his hands on the bars of a well worn but well-equipped Schwinn 12-speed. “Whad'ya think, Dad?” he asked. Only minutes later, we were headed home with the “new” bike, which is still on the road today.
There's always an uncomfortable moment when we realize that vision has met reality and something might have to give. Proponents of mental health parity experienced such discomfort in 2009 as their cherished vision, embodied in the Wellstone-Domenici Mental Health and Addiction Equity Act, met with a blizzard of complex, conflicting interpretations during its public comment period. Issues and questions, once put to rest with the Act's passage, surged back to life and threatened to derail the implementation of parity once again.
As Brian Albright reports in our cover story (page 12), the effectiveness of parity will revolve around how regulators address four critical areas in the original legislation: the definition of mental health and medical disorders; the applicability of “separate but equal” deductibles; the boundaries of medical management; and the scope of treatment services. As we await the Act's interim final implementation rules, experience tells us that these rules, the product of still more compromise, may well add a few blemishes to our nation's vision of parity in mental health and substance abuse treatment.
Should that be the case, it's time for us to narrow our gaze, look back with appreciation on an exceptional effort, and proceed. While it's possible that parity won't be all we had hoped for, it will be real and it will be ours.
Dennis G. Grantham, Senior Editor Behavioral Healthcare 2010 January;30(1):6
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