Meds as Stocking Stuffers?
As a result of Congress’ failure to compromise on competing bills authorizing Medicare prescription drug coverage, Dear Abby is recommending pharmacy gift certificates as stocking stuffers for the elderly.
I discovered this sad state of affairs a few days ago when I asked a 71-year-old relative what she would like for Christmas. After mentioning that she and her husband paid, out of pocket, $150 for their most recent prescriptions (neither has a serious chronic illness), she invoked Dear Abby’s advice.
She and her husband are both loyal Republicans, nourished by a steady media diet of Rush Limbaugh and Bill O’Reilly. When I suggested she pay closer attention to politicians’ positions on Medicare, she responded frostily that she would never vote for Hillary Clinton.
Millions of similar individual disconnects between private pain and public policy have postponed a national Medicare crisis into 2003 while further frustrating AARP and allied policy reformers. They have tried to forge a more class-conscious “Medicariat” to lobby Congress and overcome the insurance-pharma- ceutical juggernaut that has stymied efforts to make prescription coverage a government-funded Medicare option.
Invoking the specter of price controls and lower research budgets, the drug and insurance industries -- largely through their GOP allies -- have countered with bills that steer drug coverage into a private-insurer maze of subsidies, deductibles, limits and co-payments.
How bad is the situation, and what is the potential for a Medicariat? Nationally, about 30% of Medicare-eligible subscribers lack prescription drug coverage. The remainder have coverage that may contain substantial deductibles, exclusions, co-payments and annual caps.
Only three out of 10 standardized Medicare supplemental insurance plans (Medigap) cover prescriptions, and only 10% of Medigap purchasers bought prescription coverage, AARP says.
A recent Kaiser Family Foundation eight-state survey found wide variation by state and source of coverage. In California, 18% of seniors have no drug coverage; in New York, 19%; in Michigan, 25%; in Illinois and in Texas, 31%. In heavily unionized states, employer-sponsored retiree health plans were a major source of coverage -- for example, in Michigan (50%), Ohio (47%) and New York (42%). Medicare HMOs provided coverage in California (34%) and Colorado (24%) but less than 15% of coverage in other states.
This same survey contained an additional dark finding that nearly a fourth of seniors reported skipping medication doses or not filling prescriptions because of cost. Nearly a fourth of seniors are spending $100 or more a month on prescriptions. In addition, Medicare beneficiaries may be spending up to a fifth of their incomes on health care, according to a private foundation that researches health and social issues.
Medicare and its recipients are caught up in a medical-care revolution. The original 1965 Medicare legislation addressed elderly people’s great fear of long, bankrupting hospital stays. Today, “miracle drugs,” endoscopic microsurgery and other breakthroughs have reduced hospital stays and lengthened life spans.
But considerable costs are shifting to biotech devices (i.e., complex implants), the pharmacy window and, increasingly, home health care.
Congress should pass a prescription drug benefit as a prelude to rethinking Medicare altogether. (Scheduled Medicare reimbursement cutbacks have rising numbers of doctors threatening to limit or refuse Medicare patients.) Major Medicare reforms, in turn, will accompany overhauls of the nation’s creaking, expensive and outmoded health insurance system.
Americans will have to decide how much they want to spend on health care, balancing the competing “have-it-all” desires for equity, access, choice and high quality. In so doing, we may be able to abandon Scrooge-like visions of holiday gift certificates for life-sustaining drugs -- for the elderly or anyone else.
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Frederick R. Lynch is a government professor at Claremont McKenna College and is the author of “The Diversity Machine” (Transaction Paperbacks, 2001).
