Dr. Sharfstein's Introduction: The Medicare program presents perhaps the most egregious example of economic discrimination against psychiatric patients. Among national health plans in modern Western democracies, only the U.S. Medicare program specifically discriminates against outpatient mental heath services. As Mumford and Schlesinger point out in this column, today less than 5 percent of Medicare expenditures for mental illness go for outpatient care. Discrimination against outpatient services is penny-wise and pound-foolish, since early use of such services can help limit the costs of the Medicare program. Currently the program strongly discourages treatment of mental illness in older Americans.