Article: Other Voices: For seniors, no reason to give thanks

Dayton Daily News (Dec. 22, 2005)

It is becoming more apparent as we approach the end of 2005 that it will not be a Happy New Year for the two-thirds of America's seniors who will receive the new Medicare Part D drug benefit starting Jan. 1.

This new prescription drug plan is more expensive than necessary, increases costs for seniors and the health care system, cuts care and gives most of the savings to private businesses. In addition, pharmaceutical companies will be prohibited from continuing programs they now operate that offer free or reduced-priced medications to needy seniors. The sad-but-true result of this so-called reform is that — instead of older Americans — it is insurers and other businesses who will be popping champagne corks at midnight on New Year's Eve when Medicare Part D takes effect.

Of all the ways they might have chosen to help seniors purchase prescription drugs, the Medicare bureaucrats and Washington's Republican majority chose the worst.

Outsourcing bureaucracy to the private sector doesn't magically make prescription drug benefits cheaper or the system more efficient. In fact, funneling benefits through dozens of private companies makes Medicare Part D needlessly confusing. And, since private companies are profit-driven, not service-driven, they have no real incentive to help our seniors get the help and coverage they deserve. Increasing the number of plans and people that seniors need to go through will make the system more expensive, more confusing and less transparent than it should have been.

The administration claims that its new benefit is a good deal for moderate-income beneficiaries with high drug costs — people who are not eligible for Medicaid. Yet, under their plan, these people will pay not only a $250 deductible, but also 25 percent of the next $2,000 in covered costs.

In addition, Medicare Part D requires each senior to cover 100 percent of the costs over $2,000, until disaster coverage kicks in at $5,100. That's a huge $3,000 "doughnut hole" in the coverage that seniors will have to pay out of their own pockets. For many elder Americans living on fixed incomes, it might as well be called the bankruptcy hole.

The doughnut hole presents two major problems. First, low- and middle-income seniors who are already struggling to eat and keep a roof over their heads don't have an extra $3,000 for medication. Second, married couples are doubly penalized under this plan: each spouse must pay these out-of-pocket costs separately — leaving not a $3,000, but a $6,000 doughnut hole in their household.

To make matters worse, on Nov. 22, the Bush administration office of inspector general at the Department of Health and Human Services declared that pharmaceutical manufacturers who participate in the Medicare Part D program are prohibited from continuing free drug programs they offer to eligible seniors — programs that serve seniors with chronic illnesses and high drug costs.

By refusing to allow pharmaceutical manufacturers to continue helping chronically ill Medicare recipients avoid bankruptcy, the administration ensures that more of them will end up on poverty's doorstep. There is also the risk that chronically ill seniors who lose their free drugs will be forced to enter nursing homes prematurely, simply because they will not be able to afford their medications.

I have often criticized pharmaceutical companies and the policies they support, but it is also important that we compliment them when they promote sound initiatives. Rather than outlawing programs that help middle-class seniors avoid unnecessary hospitals visits and premature placement in nursing homes, we should be giving grateful thanks, and encouraging them to continue them.

When federal regulation prohibits the pharmaceutical industry from voluntarily helping needy seniors, our politics have left the realm of logic for the land of stupidity.

The specter of Medicare Part D alone is more than enough to dampen the holiday spirit. Scrooge-like shutdowns of voluntary programs that help seniors is even worse. The president should mark this holiday season by calling for the grinches in the inspector general's office to change their ruling, and to join the effort to keep elderly Americans from costly and demoralizing premature nursing home commitments.

Sometimes government officials desperate to create a firewall create a prison wall instead.

And now, the credit to the authors of the above. If I had put it at the top of the article, some would have deleted it- and so I didn't. John

Teresa Heinz Kerry is chairman of the Heinz Family Philanthropies, and the wife of U.S. Sen. John F. Kerry. Jeffrey R. Lewis is president of the Heinz Family Philanthropies. Write him at jlewis@heinzoffice.org.