Wonks Anonymous, for his sins, is exposed to all of the latest innovations in Health Insurance. Which innovations he communicates to his readers in the hope that he can work off some of his karmic debts and be released to some happier life.

So the latest rage among large employers is something called self funding. In this scheme the health insurance company runs a standard HMO or other health insurance plan for employees but, rather than billing the employer for a monthly premium, the health insurer passes all the medical bills along to the large employer who pays for them.

If the self insurance plan is an HMO the health insurer continues to provide its services, managing care so that employees do not get too much of it and making sure that doctors and hospitals do not get paid too much. In fact the whole thing looks almost exactly like standard health insurance.

Except for one very important difference. Self funded health insurance is regulated by Federal Law. I think that would be COBRA the act that allows you to buy continuing health insurance from your employer when you lose your job. Federal law does not require that health insurance cover many benefits that are mandated by state law. For example, Federal law does not require that insurance plans cover mental health or substance abuse programs.

In effect self funded insurance plans take advantage of a technicality to avoid covering real illness.

Now it would be one thing if scientific analysis had shown that mental health and substance abuse treatments were all hokum but this is hardly the case. Evidence, as developed by Kaiser Permanente among, others has shown that these treatments are effective in reducing the harm from these diseases. There are real, cost effective treatments for mental illness and substance abuse.

And no employer who is seeking to avoid paying for these treatments has ever presented a shred of evidence that leaving mental illness and substance abuse untreated really reduces lifetime health care bills. Wonks Anonymous will venture to say that there is no evidence to support such a claim. Untreated mental illness leads to suicide attempts, self inflicted injury and emergency room visits. The list of physical ills and injuries that are caused by untreated substance abuse is endless.

In fact the only motivation for this exclusion is some vague prejudice on the part of our business leaders. Mental illness is all in your head and you malingerers could overcome it if you just showed enough grit. It is shameful that health insurers are so eager to cater to these barbaric beliefs in their pursuit of profit.