August 2 2002

Commentary

Playing Politics with the Medicare Drug Benefit

By James Santiago Grisolía, MD
and Ben Medina, MD

Over recent weeks, the Latin community has watched Congress putting election politics ahead of health care for Seniors.

Currently, Medicare does not pay for prescription drugs, except in the hospital and for certain outpatient items, such as insulin and some chemotherapy drugs. Overall dollars spent on medicine have grown at least 50% in the last 5 years, due both to newer, more expensive drugs and to inflation of older drugs. Seniors without a secondary insurance such as MediCal must pay their own medicine costs, which are climbing daily. Up until now, seniors could turn over their Medicare to an HMO such as Health Net or Secure Horizons, but now these HMOs have sharply reduced their drug coverage by increasing co-pays, reducing overall dollars benefit/year, and/or dropping brand-name drugs. This leaves many seniors paying $200 monthly for the medicines of 20 years ago, because they can’t afford $800 or more per month for several of the latest, breakthrough drugs.

These rising drug costs leave seniors angry, and our politicians can be trusted to sense a hot-button issue in an election year. The Democrats produced a bill that would give medicine coverage to every senior, rich or poor, but would cost $600 billion over the next 10 years. The Republicans offered government subsidies to private insurers, focused on the poorest seniors, costing a “mere” $370 billion over 10 years.

Importantly, these cost estimates cannot factor in the continuing, unpredictable increases in drug costs due to new innovations. We now have newer, more expensive drugs for previously “untreatable” conditions like Alzheimer’s, multiple sclerosis and certain cancers. Newer, better treatments will spring from the Human Genome Project and other very expensive technologies.

Of course, both the Republican and the Democratic plans were defeated. A compromise bill was presented, but it died when the Senate voted 50 to 49 against it, Wednesday, putting the legislation on hold until after the November elections. Both sides would rather woo senior votes in the fall by blaming the other side for defeating their own bill. So far, the voices for compromise and really doing something have been outweighed by partisan jousting for control of the Senate and House in the next elections.

What would work? Clearly, total drug coverage would break the federal budget. Getting more help for seniors with limited economic means makes the most sense. Getting help for seniors and others with chronic conditions makes the most sense. Chronic disabling conditions like diabetes, hypertension and high cholesterol are more frequent in Latinos, and paying for their treatment can prevent costly complications like amputations, hemodialysis, heart attacks and stroke. So both the family and the community have an interest in preventing chronic disease.

The National Center for Policy Analysis just released a study on health insurance in South Africa, available at their website www.ncpa.org. This study shows that even seniors, when using a Medical Savings Account (MSA) spent 50% less than people in HMOs or conventional insurance, because they managed their own money and watched their purchases carefully. Importantly, the South African experiment included first dollar drug coverage for chronic conditions like AIDS or diabetes, since good preventive treatment would save society dollars down the line. There, MSAs turned out to be the most dollar-efficient coverage, giving people the best care, but needed extra coverage for “chronic condition” medicines. This seems like a solution that could be adapted to the U.S. and would benefit many Latinos.

In the meantime, while Congress fights for political advantage, ask your doctor for advice on how to lower the cost of drugs. Sometimes there is a cheaper generic which is not exactly the same, but will work for you. Sometimes you can buy double or quadruple strength pills and break them up, saving money. Sometimes, buying wholesale quantities can save money, if you’re sure you will take the same medicine. Both your doctor and your pharmacist should be knowledgeable about drug company Patient Assistance programs to get senior discounts. These programs vary from company to company, with about half asking for proof of low income. According to state law, if you have a Medicare card and must pay cash for a medicine (even if you also have Secure Horizons), you can ask for the pharmacy’s MediCal discount price, which is always less, even though you don’t have MediCal. Compare several pharmacies, including Costco, as the MediCal discounts differ among stores.

You can purchase many medicines in Mexico more cheaply, but first ask your doctor if this drug will be similar in effectiveness for you. For non-addictive medicines such as blood pressure or diabetes pills, no prescription is usually necessary to buy them in Mexico, but an American prescription is technically required to bring medicines back across the border. It is legal to bring amounts sufficient for personal use for several months. Controlled medicines such as Valium or Xanax can only be bought legally with a Mexican doctor’s prescription, and several famous cases have involved Americans jailed by Mexican customs for buying such drugs without a legal Mexican prescription.

Dr Grisolía is Communications Chair and Dr Medina is South County Counselor for the SD County Medical Society. Dr Grisolía is also Chair of Advocacy for the Epilepsy Foundation and Dr Medina is a specialist in primary care for the elderly.

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