Mind Matters - August 2007
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

Caring for Medicare
by Ron Sterling, M.D. -- August 2007

    I may be one of the very few conflict-free geriatric psychiatrists in the Seattle area when it comes to the subject matter of this article. I have opted out of the Medicare program. Not only do I not receive potential financial benefits from writing this article, I could also conclude that I may be harming my business model (Medicare opt-out services) by encouraging reduced copays for Medicare outpatient mental health services. In addition, I am not yet a Medicare beneficiary. So, listen up! There are two pieces of federal Medicare legislation that need your help.

    Currently, Medicare beneficiaries are forced to pay 50 percent of costs for outpatient mental health services (OMHS), but have to pay only 20 percent for costs related to any other covered health care services. In my opinion, this is clearly discriminatory and, given what we know, for instance, about how much untreated or poorly-treated clinical depression contributes to shortened life spans in older adults, it could be argued that such a policy is also contributing to earlier deaths of older adults.

    The two pieces of legislation that need our support are (1) Senate Bill 1715 (S.1715), Medicare Mental Health Copayment Equity Act of 2007, introduced by Senators John Kerry (D) and Olympia Snowe (R) on June 27, 2007; and, (2) House Bill 1663 (H.R.1663), Medicare Mental Health Modernization Act of 2007, introduced by Representative Pete Stark (D), chair of the House Ways and Means Subcommittee on Health, reintroduced on March 23, 2007. Both of these bills will eliminate the unfair 50-percent copay for Medicare outpatient mental health services.

    For assistance with H.R. 1663, please visit GovTrack.us (H.R. 1663). It has been referred to House Ways and Means, Subcommittee on Health. For assistance with S.1715, please visit GovTrack.us (S. 1715). It is currently in the Senate Committee on Finance. I also recommend that you contact AARP and ask them to get involved (AARP Washington, 9750 3rd Avenue N.E., Suite 450, Seattle, WA 98115; Telephone: 1-866-227-7457; Email: wa@aarp.org). I could not find a single reference to either bill by doing a comprehensive search at www.AARP.org. On March 27, 2007, the National Alliance on Mental Illness testified before Congress in support of H.R.1663 (small Adobe Acrobat document).

    You may wonder, as I have wondered, about the following questions: (1) Would increasing the Medicare subsidy for OMHS increase Medicare costs?; (2) Is there evidence that the 50-percent copay burden for Medicare OMHS actually prevents older adults from accessing important health care services?; and, (3) Would older adults utilize Medicare OMHS more appropriately even if the copay was reduced? The first question is easier to answer than the other two.

    A large number of states and the federal government employee insurance plan have documented experience with mental health parity. The data is clear -- mental health parity does not increase total healthcare expenses at all or increases them by a very small amount. The main reason that this is true is that many of the illnesses for which we consult and pay primary care physicians and other specialists often have a large mental health component. When you adequately subsidize treatment for the mental health component of physical ailments, costs go down for the treatment of physical ailments. In addition, costs go down for expensive inpatient mental health services when adequate outpatient services are provided.

    Clearly, the 50-percent copay reduces access to mental health treatment by being a significant financial obstacle to both beneficiaries and providers. A relatively large percentage of physicians and psychiatrists have opted out of Medicare. Finding a psychiatrist who is part of the Medicare program is often difficult.

    When it comes to the issue of older adults seeking mental health treatment even if the 50-percent copay is reduced to 20 percent, there are no significant studies that I can reference. While it is clear that the current generation of older adults has traditionally had more difficulty with negative attitudes and shame related to mental health treatment, those attitudes are changing quickly. -- Best wishes, Dr. Ron.

      Author Bio:

      Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Bellevue, Washington. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

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Updated October 7, 2007
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