What could sound better to the nearly 40 million seniors and disabled people covered by Medicare than a drug benefit? The image of seniors choosing between food and medications, the enormous and rising cost of prescription drugs, and the growing population of Medicare eligible people (more women than men) would lead us to applaud such a sorely needed plan.

Beware. The President and the Republican controlled Congress are pushing hard for this change, co-opting, as the next Presidential election approaches, a traditionally Democratic issue. Why? Because their hidden agenda may be to get the government out of the Medicare business altogether. The prescription drug bills passed in the House and the Senate (although different) both call for a "voluntary stand-alone drug benefit…delivered through private risk-bearing entities"¹ (managed care).

According to Trudy Lieberman, director of the Center for Consumer Health Choices, initially, "…the Bush administration had hoped to entice beneficiaries into HMO's and PPO's by offering drug benefits only to those willing to leave traditional Medicare."² But Bush changed his mind and, for the time being, both versions of the legislation fund some drug coverage for those who stay in Medicare and, thus, persuaded some Democrats like Ted Kennedy to vote for the bill. But, according to Ms. Lieberman, the issue is far from dead. If, in fact, a totally privatized Medicare program lies ahead, Ms. Lieberman suggests that one look at what happened in California over the last decade as benefits declined and costs rose for seniors in managed-care plans.

There is Still Time to Act

Currently, the two bills (House and Senate) have significant differences and the process of developing compromise legislation on this issue promises to be convoluted, lengthy and contentious. There is still time to let your representatives in Washington know that you do not support legislation that will ultimately lead to increasing out-of pocket expenditures for seniors and the disabled and/or to a managed-care strategy that has, to date, proved unsuccessful and costly to its enrollees.

Under both bills, the prescription drug coverage does not go into effect until 1-1-2006 (after the next presidential election).
In the Senate, Hillary Clinton voted against the bill. Chuck Schumer voted for it.
N.B: The US "…spends 14.1 percent of GDP on medical care, while the Canadians spend 9 percent, and the Germans spend nearly 11 percent. Both Canada and Germany insure all their citizens and have lower prices for prescription drugs." (AARP Bulletin, March 2003)
Quiz: On the prescription drug issue, who is the big winner?
a) the elderly b) all taxpayers c) insurance companies d) the government e) pharmaceutical companies

¹ Kaiser Family Foundation Report, June 2003.
² The Nation, July 2003

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