by Eric Gopelrud

A recent study from the RAND Corporation, reported in the June 26th issue of the New England
Journal of Medicine, found that alcoholism B an illness that is the third leading cause of
preventable death in this country B goes largely untreated. The study indicates that the quality of
care for alcoholism is abysmal, that screening is not routinely done, and that, when identified,
patients aren=t being referred to treatment specialists. And this isn=t surprising.
What=s keeping people from getting the treatment they need? Like many things, it has mostly to
do with money. Alcohol treatment is singled out for particularly harsh coverage limits by health
plans and insurers, making proper medical management of these illnesses financially
impossible. This deters hospitals and physicians from aggressively screening for the condition
and referring patients for care. Why bother when there is no way to pay for the treatment?
While many states pass laws requiring that private health insurance companies cover various
illnesses and injuries, we found, in our own study, that the largest health plans in one third of
states did not even meet the minimum statutory requirements for coverage of alcohol treatment.
Worse, state laws actually discourage the health system from doing its job. Insurance laws in 38
states exempt insurers from having to pay for treatment costs if a person is injured while under
the influence of alcohol.
Public health insurance programs often miss the mark. Medicare requires patients to pay 50
percent of the costs for outpatient alcohol treatment, but only 20 percent for other illnesses. The
State Children=s Health Insurance Program (SCHIP), which provides health insurance for
millions of poor children, does not require coverage of alcohol treatment, despite high rates of
alcohol problems among youth.
We can afford to do a lot better. For example, the nine million government workers and their
families covered by the Federal Employees Health Benefit Program have equitable coverage.
The cost to the program has been insignificant, an increase of far less than one percent of the
premium. Covering treatment for alcohol problems the same as for other illnesses would
increase costs by only $5.11 per person per year B about the same as two lattes at Starbucks.
What the business and insurance communities do not seem to realize is that the longer alcohol
problems go untreated, the more costly it is to the patient, to the family, to the workplace, and
ultimately, to the taxpayer. The annual bill for treating alcohol-related illnesses and injuries is
close to $20 billion.
But that=s just a fraction of the $185 billion drained from America=s coffers each year to cover
the costs generated from alcohol-related problems B costs resulting from traffic accidents,
subsequent illness and hospital fees, and unproductive missed work days. It becomes a vicious
cycle, when in fact, an investment in treatment would actually bring down both costs and the
number of alcohol-related problems.
Companies and government should encourage treatment by investing in coverage. Pinched by
rapidly escalating health care costs, the RAND researchers have pointed them toward a real
opportunity. Investing in increased access to quality alcohol treatment is good medicine and
good economics.
Eric Gopelrud, PhD, is the Executive Director of Ensuring Solutions to Alcohol Problems at the George
Washington University Medical Center, a project to increase access to alcohol treatment supported by a
grant from the Pew Charitable Trusts.