Killer Cure

[Guest guest]

http://www.alternet.org/story.html?StoryID=17165

 

 

Killer Cure

 

By Alexandra Walker, TomPaine.com

November 13, 2003

 

Be careful what you wish for. In the case of helping America's older and

disabled people afford prescription drugs, this cliché couldn't be more apt.

 

The pressure is on Congress to cover the cost of medicines prescribed to people

on Medicare. This gap in coverage evokes images of someone's grandmother – not

your own, there's something inherently remote and impersonal about this issue

for most people – carefully budgeting to make sure she can afford both her blood

pressure pills and groceries. But if Congress passes the plan currently under

consideration, that heart-wrenching scene changes only slightly. Grandma is

still counting her pennies, but now she's budgeting to make sure she can afford

the co-payment for her visit to the doctor and her home health aide.

 

 

 

And if grandma is one of those four million retired Americans who buys health

insurance through her previous employer, she may lose her insurance altogether,

as employers use government support for drug coverage as an excuse to drop

retirees from their health plans. If the push to " privatize " Medicare is

successful, grandma will no doubt feel confused and utterly frustrated.

Republicans want traditional Medicare programs to begin competing with private

HMOs. If passed, grandma may either have to pay the difference in monthly

premiums between the HMO and the traditional fee-for-service Medicare program –

the latter preferred by her and her peers – or she must enroll in the HMO and

contend with all the restrictions – like not being able to choose your own

doctor – which make HMOs such a hated enterprise in this country.

 

 

 

How did it happen that Congress is contemplating such a screwy piece of

legislation – one that purports to give people help paying for medicines yet

hikes the expenses of other basic health-care services?

 

 

 

Moneyed Interests And Ideology

 

 

 

The debate over Medicare involves so many subplots it's hard to stay focused on

the content of the competing proposals. There's the specter of the 2004

elections and the rush to bank the political currency gained from passing a good

bill or stopping a bad bill. There's the sordid tale of internal wrangling in

the House of Republicans – er, Representatives – in which Democrats are being

locked out of negotiations. There's the money in politics angle, worthy of an

episode on HBO's K Street , in which a powerful industry unleashes a

sophisticated lobbying apparatus to parlay its message across editorial pages

and over cozy lunches with congressional staff.

 

 

 

Finally, there's the ideological standoff between those who think Medicare is

one Great Society program we can be proud of, and those who believe that any

service – no matter how essential – can be better managed by a profit-making

organization. The conservatives believe the principle of guaranteed coverage for

America's seniors and disabled should be sacrificed on the altar of competition.

While pressures other than philosophy exert greater influence over the debate in

Congress, media coverage has often depicted lawmakers who call for privatizing

Medicare as motivated purely by ideology, when in fact industry lobbying has

more influence over them.

 

 

 

Despite all the dramatic overtones, getting the public to pay attention to the

issues Congress is wrangling over remains difficult. What gets lost in the

seemingly arcane details of the various proposals is that whatever Congress

produces will be a big letdown for seniors and people with disabilities anxious

for help. Numerous nonprofit organizations that promote the interests of

Medicare beneficiaries and older people – U.S. Action, Consumers Union, Medicare

Rights Center – say that the proposed plan will increase costs to beneficiaries.

As counter-intuitive as it sounds, a bill created to relieve seniors of the

expense of prescription drugs will actually result in higher costs in other

areas in order to offset the prescription drug coverage.

 

 

 

In exchange for being able to say " I passed a prescription drug coverage bill, "

politicians are willing to overlook the fact that their plan simply shifts

beneficiaries' expenses from one type of health care (medicine) to another

(increased fees for doctor visits, lab services, home health care). In this

shell game, the only victory belongs to the politician and the pharmaceutical

and insurance industries bankrolling him or her.

 

 

 

Profits Over People

 

 

 

To understand what's driving this unwieldy effort to " reform " Medicare, consider

who stands to benefit from the bills under consideration on the Hill. On

Halloween, Harvard University released a study that predicted the pharmaceutical

industry would reap a " windfall profit " of at least $139 billion over eight

years if Congress passes a drug benefit. Not a bad return on the $120 million

the pharmaceutical industry's trade association, PhRMA, spent this year to lobby

Congress.

 

 

 

The various interests in the debate over prescription drug coverage have issued

enough " line in the sand " type declarations to cross hatch an entire beach. For

the most conservative House Republicans, the battle over this legislation is

part of a larger war to subject all senior, disabled and poor Americans to

health care regulated by the marketplace, which they claim will reduce spending,

despite evidence to the contrary. Nonetheless, if the final bill does not

require Medicare to compete with private plans, conservatives will revolt. House

Republicans wish to prohibit Medicare from using its purchasing power to

negotiate with drug companies for lower prescription prices.

 

 

 

For their part, senate Democrats (and one independent and one Republican) have

in recent weeks been equally adamant in their opposition to privatization and

proposed spending caps on the program, after which more costs would be shifted

to beneficiaries. In staking out their position, these lawmakers are no doubt

aware that a Kaiser Foundation poll conducted earlier this year found that the

majority of Americans favor giving seniors a drug benefit even if it costs

taxpayers more. It would seem that Americans still believe that the younger

generation has an obligation to care for the older generation.

 

 

 

As advocates for older people and the disabled say, Medicare works. According to

the Medicare Rights Center, a nonprofit group that represents people on

Medicare, the program has radically cut the poverty rate among older Americans,

helped extend both the duration and quality of life of older Americans and has

done so by controlling costs far more effectively than any private insurance

system.

 

 

 

The nation needs to give older people and people with disabilities reliable

health coverage without breaking the bank. But what Congress is cooking up

threatens to leave a bitter aftertaste in the mouths of older and disabled

Americans. Medicare was created in 1965 because private insurers found it too

costly to insure older people, who consume four times as many health services as

younger Americans. As we face an onslaught of retiring baby boomers, it makes

sense to bolster, not dismantle, the social insurance structure of the Medicare

program.

 

 

 

Alexandra Walker is the assistant editor of TomPaine.com.

 

 

 

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