The National Psychologist

March/April 1999 Vol. 8, No. 2


Medicare can’t survive without major structural changes, commission reports

By Paula Hartman-Stein, Ph.D. and Henry Saeman

The Bipartisan Commission on the Future of Medicare, notably overshadowed by Washington’s preoccupation with the impeachment trial during the past year, hasn’t missed a beat and its anxiously awaited recommendations are to be published imminently.

How mental health will fare may not be decided for some time. In fact, the entire process now awaits review by Congress--- which may be time consuming--- and collaboration with the White House.

Judging by various reports, the commission’s premise during its yearlong deliberations has been that the entire Medicare program needs a structural overhaul. While the report will present this in bureaucratic detail, the general belief is that merely tinkering with the current Medicare system will be insufficient, and the current structure will not sustain quality care for the long term future. The expectation, after all, is that Medicare will have to serve 70 million elderly within 25 years which is more than double the current number.

The general explanation is that the commission’s recommendations will include core benefits and, in addition, a menu of plans that would be subject to competitive bidding. Mental health could be a core benefit, or it could be recommended among the menu of plans that consumers can buy into.

A report in the Feb. 8 issue of Medical Economics quotes Sen. William Frist (R-IN), a thoracic surgeon, as using the Federal Employees Health Benefits Program (FEHBP) to explain a possible model for the future. The government would pay a portion of the beneficiary’s premium (a defined benefit). The consumer would then be able to choose any of the plans in the market which might number as many as several hundred. Such a "premium support model" would allow the buyer maximum choice.

Not so fast, though. The Bipartisan Commission’s report will be scrutinized and dissected by Congress, and its shape and twists by the time it reaches the President’s desk may be filled with post-impeachment politics, and can’t be predicted.

Psychologists have been notably indifferent about the commission’s dialogue. While nurses, physicians and other organizations testified, the most salient expression seems to have originated from the National Alliance for the Mentally Ill (NAMI).

Robert Bohlman, MAMI’s director of government relations, proposed that Medicare equalize the 50% co-pay to the 80% paid for other medically necessary services. He testified that the Medicare system discriminates against persons with serious brain disorders and that, as a result, quality of life for many older adults and younger people with disabilities are diminished.

To read the proceedings of the commission, log onto their website at

Other news of interest to psychologists who treat older adults: the APA Interdivisional Task Force on Qualifications for Practice in Clinical and Applied Geropsychology has completed a report entitled "Qualifications for Practice in Clinical Geropsychology." The report presents outlines of the type of training in aging related knowledge and skills a practitioner should possess at three levels. Level 1 is general exposure to aging that all practice oriented psychologists should have. Level 2, generalist training in clinical geropsychology, is compatible with certification by the APA College of Professional Psychology, while Level 3 is that of specialist training in clinical geropsychology.

The report to be reviewed by the APA Board of Directors, then presented to the APA Council in August.


Paula Hartman-Stein, Ph.D., a psychologist specializing in geropsychology in Akron, OH, can be contacted at Henry Saeman is editor of the National Psychologist.