A reader pointed me to this article, by Miriam Axel-Lute, about the
Nonsensical Gyrations that Horizon Blue Cross Blue Shield (of New
Jersey) is going through to try to avoid paying for health care:
If you were an insurance company trying to cut your costs, how would
you do it? Emphasize prevention over cure? Cover birth control? Allow
coverage of cheaper alternatives, like in-home care over nursing homes
or examine ways to encourage use of primary care providers over the
Or perhaps you’d try to avoid paying for the treatment of
teens with eating disorders and then when you get sued, demand that
they give you their diaries, e-mails, and private MySpace and Facebook
posts to “prove” that the conditions were
“emotionally based” not “biologically
In New Jersey, Horizon Blue Cross Blue Shield, may they receive the
corporate death penalty, has chosen the latter. Of course they are
enabled in this by an asinine New Jersey law that says health insurers
are only responsible for covering mental illness when it’s
“biologically based.” …
As much as I like to harp on insurance companies, in this case they are
not entirely to blame. The state Legislature wrote the law.
Ms. Axel-Lute called the law “asinine.” I would not
have used that word.
Having said that, I do not know what word I would have used.
“Corrupt” comes to mind, although it does not exactly capture the
essence of the situation. What we have is a law that, on the
surface, seems so stupid that it is hard to believe that any politician
would consider it in good conscience.
Most likely, it was not considered in good
conscience. Rather, it was passed as a giveaway to an
industry. It was passed without consideration of the
well-being of the people who put them in office, who pay their
salaries. That is why I thought of the word “corrupt.”
This sort of thing is so common, it seems that we ought to have a word
for it. It is sort of like Eskimos not having a word for
I am sitting her trying to imagine a sensible way that insurance
company folks, or the courts, or the legislature, could possibly hope
to come up with a meaningful way to decide what illnesses are not
Really, either it is natural or it is supernatural, and I don’t believe
in the supernatural.
The mental health field did go through a controversy about this, some
decades ago. In fact, one of my favorite authors, Glen
Gabbard, wrote a nice article about in in Am J Psychiatry
in 2005. The journal allows open access for some of their
older stuff, so anyone can read it.
With abundant examples, he shows how various conditions clearly have a
biological basis, even though they also have traumatic antecedents in
some cases. These are things that formerly were considered to
be psychological, not biological. But with a little bit of
investigation, once the right methodology was developed, it turned out
that there simply is no evidence for a mind-brain dichotomy.
People have tried to find it, but it keeps not being there.
In fact, much of the earliest work in biological psychiatry
was directed specifically at the task of finding a test to distinguish
biologically-based conditions from psychologically-based conditions.
suppression test is a good example.
The DST did turn out to be useful in a research setting. It
demonstrated that alterations in the HPA axis are important in
psychiatric conditions. But it never was possible to use it
to distinguish biological from psychological conditions.
A search for “dexamethasone suppression test depression”, in PubMed,
will retrieve 1260 citations. Clearly a lot of effort went
Of course, failure to find something does not mean that it does not
exist. But at some point, after the search has gone on far a
long time and has consumed a lot of resources, the only practical
conclusion is to say that it is not there. It is ridiculous
to write a law that hinges on a distinction that no one has been able