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On the Third Hand: Violent tendencies

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What happened in Newtown, Conn., Dec. 14 is too terrifying for my brain to grasp just how terrible what happened was.

One effect that I can (barely) understand: My 10-year-old came home that evening and told me what she wants in her will.

Because she is strong, she is responsible for moving a shelf in her classroom into the “hide the students” position if the school goes into a lockdown.

On the one hand: The party who’s “at fault” in Newtown was the shooter.

On the other hand: Preventing something like that from happening again is the responsibility of every conscious adult and every organization. Fourth graders should not have to spend classroom time learning how to behave during a school lockdown.

Health insurers, disability insurers and the behavioral health and employee assistance program vendors that work with insurers have a great deal of information to offer, and, obviously, plenty of vehicles for connecting patients with mental health care professionals and facilities.

Insurance organizations and behavioral health organizations have an obligation to keep insurance administrative problems from interfering with providers’ efforts to care for patients who seem likely to be a threat to themselves or others. 

Making sure that patients with serious mental health problems that could possibly lead to violence is as much about reputation risk management and common decency as it is about complying with the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and state mental health parity laws.

My understanding, from reading press accounts about the Newtown, Conn., case, that the shooter probably had excellent health insurance, and that his parents probably had the assets to pay for excellent care out of their own resources. But, if the situation had been different, and benefit plan limitations were a major concern, what health insurance company executive or plan administrator would want to wake up in the morning and read that a suspect involved in a horrifying, high-profile crime less than an hour from Hartford had been let out of an inpatient facility early because of aggressive plan utilization management moves?

Many insurers are highly profitable, and they have cash on hand at a time when much of the rest of society does not. Insurers should and do pay payroll taxes and income taxes to help support the operation of federal, state and local government agencies, including health agencies.

But, on the third hand: There are many incomprehensibly terrible problems in the world, and every mortal individual or organization, including insurers, has limited resources.

Trying to deal with weaknesses in mental health care delivery and finance by simply looking at health insurers and health plans and saying, “Hey, just pay for more care,” is not a realistic solution.

If we try to solve the mental health care problems by waving a populist wand and imposing more mandates on commercial health insurers, plenty of people may feel good. Some insurance company executives who sincerely believe in the need to improve mental health care may feel great. To some extent, if well-designed mandates eliminate counterproductive utilization review red tape and the need for insurers to compete to a “race to the bottom” in behavioral health benefits, maybe the mandates will actually do some genuine good, by freeing company executives to provide the kind of behavioral care benefits they already want to provide.

But, in the long run, to the extent that the mandates do add costs — even expenses that are clearly justified — the insurers will end up having to pass on most of the costs on to customers. Because health plans as a whole account for only about one-sixth of national income, and commercial health insurers only a fraction of that fraction, the mandates will hit the commercial health insurance customers particularly hard and discourage people from owning health coverage.

If commercial plans tend to provide better mental health benefits than government plans, mandates that drive up commercial coverage costs could even backfire, by reducing the percentage of people who have access to the richer commercial plan mental health benefits.

To me, it seems as if the reality is that we all benefit from providing care for people with health problems that could lead to violent actions. Even if we lived in a pure Ayn Randian society, the Ayn Randian society would provide some kind of government-supervised response to this challenge.

Of course, in just about every civilized society that has existed in the real world, the government has tried to help people who suffer from severe mental illness.

The ultimate answer is that we have to do something about this, and that we ought to pay for what we do using the income taxes all of us pay to the Treasury, not by assuming that the health insurers have plenty of money and can pick up the tab all by themselves.

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