Medicare Drug Plan Far From Cure-All, Irate Retirees Find

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http://www.nytimes.com/2003/06/26/politics/26VOIC.html?th

 

Medicare Drug Plan Far From Cure-All, Irate Retirees Find

 

By SHERYL GAY STOLBERG

 

 

ASHVILLE, June 24 — After 85 years on this earth, 36 of them as a schoolteacher,

and more than 60 as a taxpayer, Vela Fox figures the government ought not forget

her in her old age. Asked about efforts by Congress to give older Americans some

relief from the high cost of prescription drugs, the normally mild-mannered Mrs.

Fox lets loose with a tirade that could shake the magnolia blooms off the trees.

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" If you want to know my opinion, " she said on Monday, taking a break from her

work teaching ceramics at a center for retirees here, " up in Washington, D.C., I

don't think they care a rip about the senior citizens. If I went up there and

had that bill written tomorrow, I would fix it to where senior citizens had

their prescription drugs paid for. Not partial, but all of it. Now that's Vela's

opinion. "

 

Mrs. Fox's opinion, passionate though it may be, will not become reality for her

and countless other elderly people who have spent years waiting for a Medicare

prescription drug benefit.

 

In Washington, President Bush and Congressional leaders praise the Medicare

legislation as historic. But here, as elsewhere in the country, retirees are

experiencing what Robert J. Blendon, a health policy expert at the Harvard

School of Public Health, calls " sticker shock " — the realization that, after so

many promises, the proposed drug benefit will look nothing like what they

expected.

 

They are confused by the complex structure of the plans, and upset that the

coverage will not begin until 2006; Mrs. Fox said she did not expect to live

that long. They do not understand why the proposals have a " doughnut hole, " a

gap in coverage.

 

Mrs. Fox, for example, spends roughly $2,400 a year — nearly one fourth her

Social Security check — on medication, and under the bills widely expected to

pass the House and Senate this week, she would still spend $1,400 to $1,750,

including a $420 premium.

 

Those who already have benefits fear they will be forced into a less generous

government plan. And there is a strong sense that Congress is all talk and no

action, and that nothing will be passed in the end.

 

Here in Nashville, some are directing their ire at a man they know well: the

Senate majority leader, Bill Frist, a Tennessee Republican and

doctor-turned-lawmaker who has made prescription drug legislation his signature

issue.

 

" Do you think anybody in Washington has any idea what people on a limited income

have to do to live? " asked Ed Human, 68, a diabetic who said he voted

Republican. Of Dr. Frist, who is independently wealthy through his stake in a

hospital corporation his family founded, Mr. Human said: " He's a nice guy,

that's fine. But he doesn't have a clue. "

 

The sentiments of Mrs. Fox, Mr. Human and others are testimony to the difficult

task Congress has before it: meeting retirees' high expectations while at the

same time keeping the cost of the benefit to $400 billion over the next 10

years.

 

Drew Altman, president of the Kaiser Family Foundation, describes the job as

" mission impossible. " So it is " absolutely critical, " he said, for lawmakers to

begin " leveling with seniors about what this does and doesn't do. "

 

Whether the retirees' anger will translate into political trouble for the

majority leader, or other Republicans, is unclear. Most political analysts agree

that should a drug benefit pass, Republicans will be the winners, taking away a

critical issue from Democrats, traditionally regarded as the party more

responsive to retirees.

 

Still, Brian McGuire, Tennessee legislative director for AARP, the organization

representing retirees, said frustration with both parties was at " a breaking

point. " Mr. Blendon, of Harvard, sees that on a national scale. In a poll

conducted with the Kaiser Family Foundation last month, he asked those 65 and

older which party did a better job on prescription drugs: Republicans,

Democrats, both or neither. The biggest percentage, 36 percent, went to neither.

 

Dr. Frist, for his part, calls the legislation historic, describing it as " a

significant and thoughtful expansion of Medicare. " But the difference between

the senator and his constituents was in plain view on Monday at the Donelson

Senior Center, one of six centers operated by Senior Citizens Inc., a nonprofit

organization that has received donations from the Frist family. (A plaque in

honor of the senator's mother is on the center's library door.)

 

At 9:30 in the morning, with the aerobics class just ending, seven randomly

selected retirees — including Mr. Human but not Mrs. Fox, who said she was busy

" playing in the mud " — gathered around a collection of wooden tables. They were

Republicans and Democrats, black and white.

 

" I hope you brought something to cool your ears off, " said LingTee Hailey, 75,

pulling out a political cartoon that she had clipped from a newspaper. It showed

a member of Congress, wearing a lab coat, explaining the features of the

proposed drug benefit — premium, deductible and so on — to a patient stripped

down to his boxer shorts. With each step, the congressman-doctor had cut off one

of the patient's limbs, until the poor soul was left only with one leg.

 

" That's how I feel, " Ms. Hailey said.

 

Ms. Hailey takes prescription medicines for high blood pressure and for macular

degeneration, a disorder that is causing her eyesight to deteriorate. The drugs

cost about $2,400 a year; Social Security, her sole income, provides $16,000.

She was startled by the fine print of the House and Senate plans.

 

Both feature a $420 annual premium and a deductible: $250 in the House and $275

in the Senate. But here they diverge. Under the House bill, Medicare would pay

80 percent of drug costs up to $2,000 a year. Then beneficiaries would absorb

all costs, up to $4,900. Finally, " catastrophic coverage " would kick in, with

Medicare paying 100 percent.

 

Under the Senate bill, Medicare would pay half of drug costs up to $4,500 a

year. Then the beneficiary would pay, until costs reached about $5,800. After

that, Medicare would pay 90 percent.

 

" There's a huge gap where you have to pay the entire thing, " Ms. Hailey said,

looking bewildered. " People who can't afford it now certainly can't afford that

in-between cost. "

 

Across town, at the Madison Station Senior Center, Lucy Seymour, 74, who along

with her husband, Fred, pays $4,000 a year in out-of-pocket prescription drug

costs, had much the same reaction. " I don't think the average Joe is going to

understand this at all. "

 

The Seymours, who say they can afford their drug bills, do not expect taxpayers

to provide Cadillac coverage for all. But they, like many others interviewed,

believe Congress should pressure pharmaceutical companies to keep the costs of

medicines down, especially when drugs are so much cheaper in Canada. " I'd like

to see some kind of probing into the pharmaceutical companies, " Mr. Seymour

said.

 

Experts say retirees typically expect a Medicare benefit to resemble the drug

coverage they had when they were working. So lawmakers on Capitol Hill,

particularly Democrats, face a stark choice: Do they vote against the $400

billion plan, saying it is inadequate? Or do they vote for it and pledge to make

it more generous later on?

 

On Tuesday, Tom Daschle, the Senate Democratic leader, answered that question.

" Most of us believe that this is the time to put what we can in the bank, " Mr.

Daschle said, " and try to improve it and build on it from here. "

 

Congress also faces the delicate challenge of trying to help people who have no

coverage while assuaging the fears of those who do. Glen Bolger, a pollster who

advises Republican candidates, says retirees who have coverage " figure anything

that happens won't be as good as what they have right now. "

 

That is the view of Glenn Rogers, 67, a retired social worker in Nashville who

takes six prescription medicines a day, including two types of insulin. Through

a plan provided by his wife's former employer, he pays a $25 co-pay for a

three-month supply of each drug. Though the Medicare benefit will be voluntary,

he worries he will lose his private coverage once the government steps in.

 

" Tell Bill Frist that if he wants our vote ever again, " Mr. Rogers said, " he

should vote against this. "

 

That is not likely to occur. The plans may pass Congress as soon as Thursday.

 

Vela Fox was among several who found it hard to believe that Congress was

finally about to act. As she put the finishing touches of glaze on a ceramic

vase, Mrs. Fox, her face etched with the signs of her years, looked up from her

work and declared herself skeptical.

 

" They have been saying, `Oh, we are going to do this and we are going to do

that,' " she said, wagging a gnarled finger in the air as she spoke. " And then

Congress goes home and plays golf, and that's that. "

 

 

 

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