Give Us a Medicare Drug Benefit
By Robert Hayes
Starting this year, the United States is appropriating hundreds of billions of dollars to meet a basic human need – affordable prescription medicine for older Americans and people with disabilities. This should be a moment of celebration. But it's not.

For nearly 40 years, Medicare has been a national treasure. It is a program that has done what it promised: Americans live better and longer thanks to Medicare. Illness in old age is no longer a straight line to the poorhouse, and the efficiency of this single-payer, national health plan far outpaces the most profitable private health plans.

“Today, Medicare achieves the highest satisfaction rates of any health coverage program by far. Why? Medicare allows doctors to decide what health care is necessary for a patient. Medicare allows people to choose their doctors, therapists and hospitals. Virtually all health care providers accept Medicare.”
As the new federal drug program began rolling out this January, millions of Americans are confused, angry and frustrated. Many could not get the medicine to which they were entitled. There is a simple reason for this: the designers of the new drug benefit ignored the lessons of what has made Medicare great. And the route to fixing it is to go back to what we know works.

President Lyndon Johnson signed legislation creating Medicare on July 30, 1965. Just 11 months later the program was up and running, and 93 percent of eligible men and women voluntarily enrolled in the new, untested program. Today, Medicare achieves the highest satisfaction rates of any health coverage program by far. Why?

Medicare allows doctors to decide what health care is necessary for a patient. Medicare allows people to choose their doctors, therapists and hospitals. Virtually all health care providers accept Medicare. People with Medicare understand the services that are covered, and they can calculate ways to meet their out-of-pocket health care costs.

Reliable and affordable: these are the principles that have made Medicare a success story. And cost containment has been achieved with a largely winning formula of paying health care providers just enough to keep them in Medicare but not so much that commercial profiteering takes control.

These are the lessons that were lost on the designers of the new drug benefit, and a return to these values - reliability and affordability - should lead Congress to enact a real Medicare drug benefit.

Wait, isn't that what was launched on January 1?

To the contrary, this drug benefit has little to do with the Medicare program that has so enriched our nation. What Congress enacted is a cottage industry of for-profit drug plans competing for the business of people with Medicare.

When for-profit drug plans commit hundreds of millions of dollars to promotional and advertising campaigns to win enrollees to their tax-subsidized bill of goods, something is wrong. And when one-time statesmen, such as former Senators Robert Dole (R-KS) and John Breaux (D-LA), become mercenary pitchmen for these plans, something is very wrong.

The for-profit drug plans force older Americans and people with disabilities to make choices that no one in our nation should have to make - between a drug plan that covers their drugs but is not affordable and one that is affordable but does not cover their drugs; between a drug plan that covers their drugs today but may not meet their needs tomorrow; and a drug plan that does not meet their needs today but may meet their needs tomorrow.

Medicare is about providing health security, affordable coverage and reasonable choice. The new drug program is the opposite. Some people - especially poor people without any drug coverage - will receive substantial help if they can make their way through the application process for the low-income subsidy and find a plan that meets their needs. Many more will receive inadequate help. The benefit is limited, and people will be forced into wrong choices by the complexity of the plans and by the misleading promotions blanketing the market.

Perhaps most will ignore the program. These are people in need of affordable medicine but unable to navigate the crazy quilt of plans with their dizzying array of copayments, deductibles, coverage gaps and changing list of covered drugs. To date only 7 million people with Medicare have voluntarily enrolled in the new drug benefit. The American taxpayer should be getting a lot more for the 1.2 trillion dollars this "benefit" is projected to cost over the next 10 years.

This is the beginning, not the end. A more enlightened Congress will see the waste and hardship this program presents and enact a real Medicare drug benefit. Drug coverage should be like all other Medicare benefits: available under Original Medicare anywhere in the country in a reliable, comprehensible and comprehensive way. It should be a Medicare benefit, managed by Medicare to drive drug prices to a level that will enable people with Medicare and the American taxpayer to get a dollar's worth of medicine for a dollar paid.

– Robert Hayes, an attorney, is president of the Medicare Rights Center (www.medicarerights.org).



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