Testimony & Statements
AAGP Supports Stark/Wellstone Medicare Mental Health Parity Bill "Medicare Mental Health Modernization Act of 2001"
Statement from the Press Conference, Room 328, Russell Senate Office Building
Stephen Bartels, M.D., M.S.
President, American Association for Geriatric Psychiatry
April 4, 2001
Good afternoon. I am Dr. Stephen Bartels, the President of the American Association for Geriatric Psychiatry (AAGP). AAGP is an organization of health care clinicians and researchers dedicated to promoting the mental health and well being of older Americans and improving the care of those with late-life mental disorders. I am here today to express our strong support for the "Medicare Mental Health Modernization Act of 2001" which would help to end the arbitrary and discriminatory limitations on mental health services under Medicare, and provide older Americans with the access to mental health care that they deserve. Currently, when a person with Medicare goes to a doctor for treatment of heart disease, Medicare pays 80% of the bill, and the patient is responsible for 20%. However, when that same person sees a doctor or other mental health provider for a mental or emotional disorder, Medicare pays only 50 percent of the bill, leaving the remaining 50% to the patient. This is quite simply, discrimination. And it is time to say "enough".
I am here today representing thousands of researchers and health care professionals to plainly say that there is absolutely no justification for treating mental health care any differently from general health care. Consider for example, the problem of depression that affects one-in five Americans. Similar to diabetes or high blood pressure, depression results in diminished quality of life and is a killer responsible for thousands of preventable deaths. Not only is depression associated with higher rates of mortality in medical disorders, but depression is also a precursor to suicide. Senior citizens over age 75 have the highest rate of suicide compared to any age group. Also like diabetes or high blood pressure, depression is treatable. Treatment of depression with medications and other forms of therapy are as effective, and in many cases, more effective, than many treatments for common medical problems.
So why, then does Medicare pay for only half of the bill for the treatment of depression, and 80% for the treatment of these other health problems? The answer is shamefully simple: Medicare policy has a built-in bias against people with mental and emotional disorders. This bias comes from a time over 35 years ago when the Medicare legislation was first introduced and the stigma of mental health problems was universal. The last three decades have seen advances in the public’s understanding of these common problems that touch all American families as well as dramatic advances in treatments.
Current Medicare law is also penny wise and pound-foolish.
The social and economic costs of mental and emotional disorders in older persons are enormous. Not only are problems such as depression, anxiety disorders, alcohol abuse, Alzheimer’s disease, and other mental disorders projected to dramatically increase with the aging of the baby-boomer population, but their impact is already having significant consequences on the health care delivery system and family members.
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Research shows that older persons seeking care for common medical problems have more visits to their primary care physician, use more medications, and are more likely to have emergency room or hospital admissions when their medical problem is accompanied by depression or some other emotional disorder. In addition, outcomes of medical treatment are worse when complicated by mental health problems. For example, rehabilitation from a hip fracture or a heart attack is less successful and more expensive when complicated by depression.
In short, we are already paying for the costs of untreated mental and emotional disorders through greater health care expenditures associated with these disorders and the additional costs of poor health outcomes.
Be assured that the disparity in Medicare coverage for mental and emotional disorders is not just a problem for America’s seniors, it is a concern for American’s of all ages...from the current baby boomer generation whose lives are profoundly affected by parents with depression, Alzheimer’s disease, alcohol abuse, and other mental disorders…and who themselves will soon reach retirement age...to America’s grandchildren who deserve to spend time with grandparents who have had the benefit of appropriate and adequate treatment. It is now time to provide the means to assure that Americans have access to evidence-based treatments of mental disorders with coverage equal to other medical disorders. We would all be outraged if Medicare beneficiaries with cancer were told that they are now responsible for half of the costs of their treatment, when other disorders are covered at 80 percent. So why is it reasonable to tell a 75-year-old man with major depression resulting from a devastating loss or terminal medical illness that he is now responsible for half of the cost of his mental health treatment?
The final reason why the Stark-Wellstone bill is so important, and why current Medicare policy on mental health care makes no sense, is so much second nature to me as a physician that it only occurred to me as I was traveling here to speak to you today. As one who has spent his career treating older persons, and teaching young doctors how to treat older persons who commonly have multiple chronic medical problems, it is seldom clear where these medical disorders end and where mental health problems begin.
For example, in seeing an older woman under treatment for breast cancer and kidney failure with a poor appetite, low energy, and a waning will to live, it is not clear where the symptoms of the medical problems end, and where the depression or other mental health problems begin. There is no bright line…the psychological and the medical are intrinsically interwoven….and as philosophers have been telling us for centuries, the mind and the body are, in fact, connected. It not only is fiscally and ethically unsound to treat medical and psychiatric symptoms differently, it also makes no clinical sense.
It is only good care to treat mental and medical disorders the same, and Medicare should be about good care, not substandard care for America’s seniors.
In closing, current Medicare law on mental health coverage is not good health policy. It is blatant discrimination, plain and simple, and it should no longer be tolerated. The American Association for Geriatric Psychiatry is pleased to wholeheartedly support the "Medicare Mental Health Modernization Act of 2001" which will eliminate the last bastion of discrimination for Medicare beneficiaries. We look forward to working with Senator Wellstone and Congressman Stark to achieve its enactment as soon as possible. Thank you very much
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