Stories

Medicare for All's missing mental health discussion

Illustration of a health plus on a therapist couch.
Illustration: Aïda Amer/Axios

America's mental health care system is in dire need of an overhaul, but the any real specifics are largely missing from the 2020 debate about health care.

Why it matters: Suicide and drug overdose rates continue to rise, and the U.S. faces a shortage of mental health providers and a lack of access to treatment.

The big picture: Private insurance is plagued with holes in mental health coverage. Even even though insurers are legally required to cover behavioral health the same way as physical health, they don't.

Yes, but: Medicare to All may not solve the problem, Mental Health America president and CEO Paul Gionfriddo told me.

  • “Medicare would need to be redesigned significantly," he said.
  • Medicare has its own coverage flaws. It would also be crucial to design a system that encourages preventive and early identification services rather than just post-crisis care.

There's also a shortage of mental-health providers. Paying mental health providers more could help address this, but care delivery would also need to be redesigned, Gionfriddo said.

  • Rural areas, for example, would likely still struggle to attract and support these providers because of their remoteness and population size.
  • "The big wild card is how many mental health providers would participate in a Medicare for all program or opt out of insurance entirely," said the Kaiser Family Foundation's Larry Levitt.

For Democrats who support Medicare for All, highlighting how it could help mental health care could have a political upside.

  • “Talking about mental health care needs humanizes the candidates, indicts the shortcomings of private insurance and provides rationale for the need for significant reforms around the current system," Democratic health consultant Chris Jennings said.

The bottom line: "We have a huge problem with health insurance for mental health. A major reform could be an opportunity to improve mental health services, but it could also do harm to them," Gionfriddo said.

Go deeper: Mental health coverage is getting worse