The Fate of Mental Health Services in Health Care Reform: II. Realistic Solutions

in the second part of a two-part paper, the three major proposals for U. S. health care reform—the government-sponsored model, the employment-based model, and the market reform model—are reviewed. Barriers to their success include the currect economic crisis, the lack of a clear consensus, and the high costs of the proposals. Most proposals limit the extent of psychiatric coverage; some exclude such coverage from minimum benefit packages, an area of concern for clinicians. The author concludes that any substantial health care reform is unlikely in the near future. A thoughtful, realistic, and yet vigorous strategic plan is needed now to forestall the possible exclusion of significant mental health coverage. The basic elements of such a plan are reviewed.