Medicare should be reformed to do a better job of providing optimal care to seniors, testified Health and Human Services Secretary Tommy Thompson before the House Ways and Means Committee last month.

That was one of eight reform principles Thompson noted as part of President George W. Bush’s effort to influence the debate in Congress over how to modernize Medicare.

Thompson also presented a new administrative initiative to give physicians and other providers more input into Medicare operations (see article below).

These are the other principles Thompson highlighted from the Bush administration’s framework for strengthening Medicare:

• Beneficiaries should have the option of a subsidized prescription drug benefit.

• Beneficiaries should have better coverage for preventive care and serious illness.

• Beneficiaries and those approaching retirement age should have the option of keeping the traditional fee-for-service plan without changes.

• Beneficiaries should have better health insurance options—for example, ones that are similar to those available to federal employees.

• Medicare legislation should strengthen the program’s long-term financial security.

• Medicare’s regulations and administrative procedures should be updated and streamlined, while the instances of fraud and abuse should be reduced.

• Medicare should encourage high-quality health care for all seniors.

APA commended Bush in a letter last month for proposing Medicare reforms. APA President Richard Harding, M.D., agreed with Bush’s statement in the framework released last month that "Medicare’s outdated benefits package doesn’t protect beneficiaries against the high costs of treating serious illness."

He noted this is particularly true of Medicare’s "historic, discriminatory, and outdated coverage of mental illness."

Medicare patients pay a larger share of their psychiatric treatment costs out of pocket due to a 50 percent copayment requirement for outpatient psychiatric services. "All other Medicare Part B services require a patient copayment of 20 percent," wrote Harding.

Medicare also limits treatment in freestanding psychiatric hospitals to 190 days in a patient’s lifetime, said Harding. "This creates coverage shortfalls for those Medicare beneficiaries whose serious mental illnesses require them to be hospitalized at various points in their lives. This arbitrary limit doesn’t exist for general hospitals," wrote Harding.

He called on Bush to help millions of Americans with mental illness by supporting efforts to reform these discriminatory features. Harding referred to the legislation introduced by Rep. Marge Roukema (R-N.J.) in February (HR 599) and Sens. Olympia Snowe (R-Maine) and John Kerry (D-Mass.) in May (S 841) that would repeal the 50 percent copayment for outpatient psychiatric services (Psychiatric News, June 1).

The Medicare Mental Illness Nondiscrimination Act had 54 cosponsors in the House and two in the Senate at press time.

"Enactment of this change would simply require our patients to pay the same 20 percent copayment they would otherwise pay if they saw their internist for the flu, their endocrinologist for diabetes, or their cardiologist for heart disease," wrote Harding.

He commended Bush’s principle that Medicare should provide better insurance options similar to those available to federal employees. "We agree, and draw your attention to the fact that the Federal Employees Health Benefits Program now requires parity coverage of treatment for mental illness," continued Harding.

He also commented on Bush’s principle that all seniors should have an optional subsidized prescription drug benefit. "Some of the most exciting and promising developments in prescription drugs relate to more effective pharmacotherapeutic treatment for mental illnesses such as depression, bipolar disorder, schizophrenia, and Alzheimer’s disease."

Because 20 percent of seniors in the general population and 40 percent of seniors in primary-care settings experience symptoms of depression, having a prescription-drug benefit that provides greater access to medications would clearly benefit older and more disabled Americans, he stated.

"APA welcomes the opportunity to work with you to seize this historic opportunity to reform Medicare’s outdated treatment coverage of mental illness," wrote Harding.

The president’s "Framework to Strengthen Medicare" is available online at www.whitehouse.gov/news/releases/2001/07/medicare.pdf. ▪