My friend Barb reminded me this morning that the big picture of reality never matches the big picture of our expectations. But, she said, when we focus on a smaller level, we can find bits of hope.

The big picture of the global economy and how U.S. officials are responding to it is frustrating and disappointing. A close look at the bailout bill, however, shines a ray of hope on my attitude. It turns out that
H.R.1424, which came to be known as the Emergency Economic Stabilization Act of 2008, began its life last March as the Paul Wellstone Mental Health and Addiction Equity Act of 2007. The only reason the original bill didn’t die is that earlier this month it became a convenient vehicle for the economic bailout legislation.

It would have brightened my day to know that the Bailout Bill included a “sweetener” add-on that established mental health parity in health insurance law. The real situation is sweeter: The economic bailout was actually a set of laws and earmarks tacked onto a bill establishing mental health parity.

The full bill is nicely summarized by Govtrack.us. The mental health parity portion of the bill says that when a health insurance policy covers both medical/surgical and mental/substance-abuse issues, it must cover them equally. U.S. law now (finally!) recognizes that major depression, schizophrenia, bipolar disorder, and other mental health diseases, as well as substance abuse disorders are every bit as real as cancer, broken bones, and heart disease. The bill establishes that mental health must be regarded with parity to other medical issues, such that:

(1) the financial requirements, such as deductibles and copayments, applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan;

(2) there are no separate cost sharing requirements that are applicable only with respect to mental health or substance use disorder benefits;

(3) the treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan; and

(4) there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.

Requires the plan to provide out-of network coverage for mental health or substance use disorder benefits if the plan provides coverage for medical or surgical benefits provided by out-of network providers.

I have experienced firsthand how complicated and frustrating it is to deal with a double standard in my health insurance policies. If my lungs are congested, I can see my family doctor. If I break my wrist, I can go to the emergency room. But if my brain isn’t working right, I have to wade through complicated restrictions and procedures in order to receive affordable care. And even then, therapy is poorly covered and the number of sessions each year are over-limited.

When the world is that difficult and rotten, I, like many people, look at the big picture of our civilization and despair. But when I look closer, I see reason for hope. Mental health is slowly being acknowledged as an inseparable component of “human health” generally. And as of Friday, Connecticut at least is realizing it can’t treat gays as second-class citizens. I see regular instances of how male chauvinism is becoming more disgusting and less tolerated every year.

Is humanity truly progressing? I’m not nearly qualified to weigh in on that. What I do know is that when I look at the big picture, I don’t see black darkness. I see enough points of light to navigate the crazy world and to maintain hope that there may be brighter things still to come. Thanks to this mental health parity law, I think my mind will be healthy and alert enough to acknowledge that hope over the full course of my life. I hope it’s a long and full one.