Medicare overhaul is overdue

March 17, 2003|By Jonathan Weiner

MANY SENIORS unquestionably are having a tough time paying for prescriptions, but they'll have to take a number and get in line. This is only one of the many critical issues facing our Medicare program and the rest of our out-of-whack health care system.

Finally, there's a glimmer of hope. President Bush and the Democrats in Congress have just unveiled their dueling plans for adding drug coverage to this huge federal program. This time they have vowed to succeed before the next election.

This year, Medicare beneficiaries, on average, will each use more than $2,000 worth of prescription drugs, but the current program covers almost none of the expenses.

Legislation to fill the Rx gap will cost an additional $40 billion to $90 billion a year. But the added cost could bring the whole kit and caboodle crashing down like a lead balloon, unless a Medicare overhaul is part of the package.

OK, you ask, what should we do?

First and right away, we must add drug coverage for seniors in trouble with the focus on helping those with low incomes and catastrophic drug costs. That's the logical and ethical thing to do, as long as more than 38 million Americans under 65 have no insurance whatsoever.

Second, we should encourage more self-sufficiency for our seniors through private "Medigap" policies. These policies already cover a big chunk of the pharmacy expenses for many seniors, and the government should provide tax incentives to employers and higher-income retirees to encourage participation.

Third, we must develop rational approaches for determining what services Medicare can and cannot afford, using pharmaceuticals as a model. When an effective $15 generic drug is available, it makes little sense for taxpayers to subsidize the $150 "wonder drug" advertised on last night's glitzy TV commercial.

Finally, when we add drug coverage, it must be part of major Medicare reform. We need to reshape today's undisciplined, unbudgeted and unaccountable health care delivery system. Whether it's done by government, the much-maligned HMOs or some new entity, the care provided to Medicare's 40 million elderly and disabled patients must be better managed and coordinated.

There's a great deal at stake that will require the biggest piece of health legislation in decades. It will have lasting effects on the pharmaceutical and insurance industries, doctors and hospitals and the current and future generations of Americans. As this debate unfolds, things will get real nasty. Trust me.

No, it won't be easy, but somehow our leadership - Republican and Democrat alike - must find the fortitude to stand up to both special interests and the unrealistic voters who want it all.

We can and must get on with real Medicare reform. While many are in need of more pills, please spare us the placebos.

Jonathan Weiner is a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

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