Medicare: Prescription Coverage

[Guest guest]

Killer Cure

 

By Alexandra Walker, <http://www.tompaine.com>TomPaine.com

November 13, 2003

 

Be careful what you wish for. In the case of helping America's older and

disabled people afford prescription drugs, this cliché couldn't be more apt.

 

The pressure is on Congress to cover the cost of medicines prescribed to

people on Medicare. This gap in coverage evokes images of someone's

grandmother not your own, there's something inherently remote and

impersonal about this issue for most people carefully budgeting to make

sure she can afford both her blood pressure pills and groceries. But if

Congress passes the plan currently under consideration, that

heart-wrenching scene changes only slightly. Grandma is still counting her

pennies, but now she's budgeting to make sure she can afford the co-payment

for her visit to the doctor and her home health aide.

 

And if grandma is one of those four million retired Americans who buys

health insurance through her previous employer, she may lose her insurance

altogether, as employers use government support for drug coverage as an

excuse to drop retirees from their health plans. If the push to " privatize "

Medicare is successful, grandma will no doubt feel confused and utterly

frustrated. Republicans want traditional Medicare programs to begin

competing with private HMOs. If passed, grandma may either have to pay the

difference in monthly premiums between the HMO and the traditional

fee-for-service Medicare program the latter preferred by her and her peers

or she must enroll in the HMO and contend with all the restrictions like

not being able to choose your own doctor which make HMOs such a hated

enterprise in this country.

 

How did it happen that Congress is contemplating such a screwy piece of

legislation one that purports to give people help paying for medicines yet

hikes the expenses of other basic health-care services?

 

Moneyed Interests And Ideology

 

The debate over Medicare involves so many subplots it's hard to stay

focused on the content of the competing proposals. There's the specter of

the 2004 elections and the rush to bank the political currency gained from

passing a good bill or stopping a bad bill. There's the sordid tale of

internal wrangling in the House of Republicans er, Representatives in which

Democrats are being locked out of negotiations. There's the money in

politics angle, worthy of an episode on HBO's K Street , in which a

powerful industry unleashes a sophisticated lobbying apparatus to parlay

its message across editorial pages and over cozy lunches with congressional

staff.

 

Finally, there's the ideological standoff between those who think Medicare

is one Great Society program we can be proud of, and those who believe that

any service no matter how essential can be better managed by a

profit-making organization. The conservatives believe the principle of

guaranteed coverage for America's seniors and disabled should be sacrificed

on the altar of competition. While pressures other than philosophy exert

greater influence over the debate in Congress, media coverage has often

depicted lawmakers who call for privatizing Medicare as motivated purely by

ideology, when in fact industry lobbying has more influence over them.

 

Despite all the dramatic overtones, getting the public to pay attention to

the issues Congress is wrangling over remains difficult. What gets lost in

the seemingly arcane details of the various proposals is that whatever

Congress produces will be a big letdown for seniors and people with

disabilities anxious for help. Numerous nonprofit organizations that

promote the interests of Medicare beneficiaries and older people U.S.

Action, Consumers Union, Medicare Rights Center say that the proposed plan

will increase costs to beneficiaries. As counter-intuitive as it sounds, a

bill created to relieve seniors of the expense of prescription drugs will

actually result in higher costs in other areas in order to offset the

prescription drug coverage.

 

In exchange for being able to say " I passed a prescription drug coverage

bill, " politicians are willing to overlook the fact that their plan simply

shifts beneficiaries' expenses from one type of health care (medicine) to

another (increased fees for doctor visits, lab services, home health care).

In this shell game, the only victory belongs to the politician and the

pharmaceutical and insurance industries bankrolling him or her.

 

Profits Over People

 

To understand what's driving this unwieldy effort to " reform " Medicare,

consider who stands to benefit from the bills under consideration on the

Hill. On Halloween, Harvard University released a study that predicted the

pharmaceutical industry would reap a " windfall profit " of at least $139

billion over eight years if Congress passes a drug benefit. Not a bad

return on the $120 million the pharmaceutical industry's trade association,

PhRMA, spent this year to lobby Congress.

 

The various interests in the debate over prescription drug coverage have

issued enough " line in the sand " type declarations to cross hatch an entire

beach. For the most conservative House Republicans, the battle over this

legislation is part of a larger war to subject all senior, disabled and

poor Americans to health care regulated by the marketplace, which they

claim will reduce spending, despite evidence to the contrary. Nonetheless,

if the final bill does not require Medicare to compete with private plans,

conservatives will revolt. House Republicans wish to prohibit Medicare from

using its purchasing power to negotiate with drug companies for lower

prescription prices.

 

For their part, senate Democrats (and one independent and one Republican)

have in recent weeks been equally adamant in their opposition to

privatization and proposed spending caps on the program, after which more

costs would be shifted to beneficiaries. In staking out their position,

these lawmakers are no doubt aware that a Kaiser Foundation poll conducted

earlier this year found that the majority of Americans favor giving seniors

a drug benefit even if it costs taxpayers more. It would seem that

Americans still believe that the younger generation has an obligation to

care for the older generation.

 

As advocates for older people and the disabled say, Medicare works.

According to the Medicare Rights Center, a nonprofit group that represents

people on Medicare, the program has radically cut the poverty rate among

older Americans, helped extend both the duration and quality of life of

older Americans and has done so by controlling costs far more effectively

than any private insurance system.

 

The nation needs to give older people and people with disabilities reliable

health coverage without breaking the bank. But what Congress is cooking up

threatens to leave a bitter aftertaste in the mouths of older and disabled

Americans. Medicare was created in 1965 because private insurers found it

too costly to insure older people, who consume four times as many health

services as younger Americans. As we face an onslaught of retiring baby

boomers, it makes sense to bolster, not dismantle, the social insurance

structure of the Medicare program.

 

Alexandra Walker is the assistant editor of

<http://www.TomPaine.com/>TomPaine.com.

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