March 14, 2003


Prescription Drugs and The Future of Medicare

By: James Santiago Grisolía, MD

Pressured by seniors, politicians of both parties have called for adding a prescription drug benefit to Medicare. Currently, Medicare pays most of physician and hospital charges. However, the cost of medications is not covered, except for medications given during a hospital stay, or certain outpatient injectables like cancer chemotherapy drugs. The rapidly rising cost of medications (about 50% over the last 5 years) has left many seniors forced to choose between food, housing and medications.

Recently, President Bush has offered a prescription payment plan, but the coverage would be greater for seniors who sign up for preferred provider networks or for HMOs run by private health plans such as Secure Horizons or HealthNet. This idea sparked immediate criticism from Democrats, who would like to see medication benefits extended to all seniors. Congressional Republicans are working on their own plan.

As currently structured, Medicare will go bankrupt in about 20 years. This is because the current 2.9% payroll tax will stay fairly stable, as the number of American workers is not expected to rise much. However, the number of seniors will double, and within that group the “oldest old” are growing more rapidly, who require more expensive health services. Overall, within a few years Medicare would be spending 1.5 trillion dollars yearly, while program funding would stay fixed at about 250 billion dollars a year. Depending on how much we spend to give prescription drugs to seniors, the “tipping point” will happen sooner.

Lawmakers must come up with an entire new structure for Medicare, but any change that increases costs or reduces choices for America’s seniors will meet stiff resistance from AARP and other senior groups. On the other hand, cutting pay to providers has already reached its limits. Doctors and hospitals are already caught between fixed payment offered by the government or the health plans, versus the growing needs of seniors with multiple chronic conditions and a desire for the newest and best treatments. In California, many doctor groups and hospitals have already been bankrupted by getting caught in the middle,

If our leaders screw up the courage to make tough choices on Medicare, it seems likely that the hardest changes will be saved for today’s middle-aged workers, to buy the political cooperation of senior groups. This means that today’s workers must pay close attention to this debate, and take advantage of opportunities to save health care dollars in Medical Savings Accounts and similar IRA-like tax-protected vehicles against the likelihood that future Medicare benefits will be scaled back.

Today’s seniors may get some relief on prescription drug costs, but in the meantime, anyone without MediCal (for low income seniors) or Tricare (for retired military) must look carefully at drug costs. If you have a supplemental plan or other secondary coverage besides Medicare, ask for a 3 month mail-order prescription program; these often have major discounts. If your doctor prescribes an expensive brand name drug, always ask if there is a generic medicine that would be nearly as good. Ask your doctor if the medication can be safely purchased in Tijuana, or investigate the discount internet pharmacies operating out of Canada. Lastly, all California pharmacies must offer a special discount price to any senior with a Medicare card paying cash for a medicine, even if you’ve signed up with an HMO.

Dr Grisolía is Chief of Neurology at Scripps-Mercy Hospital and Communications Chair of the SD County Medical Society.

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