In the months since the Democratic primaries began, South Bend Mayor Pete Buttigieg has been criticized from the left for being an "empty suit," a young charismatic operator who speaks multiple languages but doesn't have much to say. But on Friday morning, he released a relatively detailed plan meant to combat suicides and overdoses, which he calls "deaths of despair," and address mental health concerns more broadly. In that 19-page white paper, the youngest halfway viable 2020 presidential contender highlights an epidemic that has hit his fellow millennials particularly hard and promises to "ensure that everyone feels that they belong in their community and in our country."

Evidence of this epidemic abounds. Almost a quarter of young people say they don’t have a single friend, indicating a shocking level of loneliness. They’re also hit hard by so-called "climate despair," anxiety related to the seemingly insurmountable disaster of a warming planet. Buttigeig's proposals include launching a national service program focused on climate and helping older Americans that will allow those young people to channel their existential anxieties into something productive while also forming bonds between the generations. His plan also calls for decriminalizing all drug possession and extending student loan forgiveness to people who work in rural hospitals, among other things.

At the center of Buttigieg's plan is a push to provide mental health services to everyone who needs them. He hopes to achieve "mental health parity," a term that refers to mental checkups being treated the same as physical checkups by insurance plans. "If a health plan offers unlimited doctor visits for medical or surgical services, it must do the same for mental health and addiction services," as the paper puts it.

There have been previous efforts to achieve mental health parity, including the Affordable Care Act, which 2020 frontrunner Joe Biden described to CNN as a "breakthrough" for parity. But requirements to cover mental health treatments are sometimes ignored by insurers, and there are still significant gaps in the system. According to data from Mental Health America, almost 56 percent of adults living with a mental illness in the United States went without treatment last year. Part of the problem, as Buttigieg's white paper points out, is that mental health checkups are five times more likely to be classified as out-of-network than other doctor visits. That leaves people wondering if they should go into debt to pay for necessary out-of-network therapy, a choice they shouldn't have to make in a well-functioning healthcare system.

According to the National Institutes of Health, four out of every five people with a substance use disorder never receive treatment, largely because they can’t afford the out-of-pocket expense, and about 60 percent of people with a mental illness haven't received any services in the past year. Buttigieg proposes requiring all insurance companies to annually report how much they’ve complied with the mandate for parity, and then fining them, or identifying them and publicly shaming them, if they don’t fully achieve it. (He also plans to enforce parity in Medicare and Medicaid, though he doesn’t suggest how that will be paid for.) The idea is that if people could more easily access mental health services through government intervention, they’d be less likely to become addicted to drugs, die by suicide, or just generally suffer.

Although President Donald Trump has gestured vaguely to mental health reform after back-to-back shootings in El Paso and Dayton this month (itself a misstep given that making such comments in connection to gun violence misrepresents the experiences of the vast majority of people with mental health issues), his critics have been quick to point out that he’s contributed to the crisis by both allowing people to stay on short-term plans that often don’t include psychiatric benefits, and by requiring people to work in order to receive Medicaid.

Other Democratic candidates have released plans related to mental health or at talked about it on the campaign trail, but few are as ambitious or far-reaching as Buttigieg's proposals. Elizabeth Warren helped introduce a bill last year that would strengthen parity laws, though it didn’t propose punishments for non-compliant insurance companies. Medicare for All, Bernie Sanders's signature policy that has been endorsed by other 2020 candidates including Warren, would give people mental health treatment through government-provided insurance while eliminating private insurers.

Buttigieg, who has called plans like Medicare for All "questionable on their merits," evidently doesn't want to go that far. But his plan is a tacit acknowledgement that insurers are failing patients when it comes to mental health, and that at least in one area of policy, radical action is needed.

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