Kudos To Pfizer; Now Fix Medicare

As President Bush noted in his State of the Union address, the economic stimulus plan is not the only unfinished business facing Washington. Congress also needs to find a way to provide Medicare recipients with prescription drug coverage.

But the President was right to insist that Congress not tackle the problem in isolation, but as part of a broader effort to strengthen Medicare. We need “to give seniors a sound and modern Medicare system that includes coverage for prescription drugs,” he said — the emphasis on “sound and modern.” Prescription drug coverage is a must because prescription drugs are an integral — and critical — part of modern medicine.

Most seniors, to borrow from an old television commercial, can’t leave home without them. Drugs to combat high blood pressure, high cholesterol levels, osteoporosis, chronic pain, and an endless list of other potentially life threatening and crippling conditions. But these medicines can be very expensive.

A friend of mine was standing in line the other day at a Safeway pharmacy in Virginia. Ahead of him was a young man in his late 20s or early 30s, who was picking up two prescriptions for his children. The tab came to $70. While this was probably an unusual expense for the young father, many seniors take prescription drugs as a matter of routine, day in and day out. And they will continue to do so for the rest of their lives.

If Medicare is their only insurance, they can have out-of-pocket drug costs of hundreds of dollars per month. In rare cases, even more. Clearly, something needs to be done. One pharmaceutical giant, the Pfizer corporation, recently stepped up to the plate with a partial but impressive solution — announcing that it would provide low-income seniors and disabled individuals with a one-month supply of any Pfizer drug for $15.

The Pfizer “Share Card” plan will be available [for information call 1-800-717-6005] to any Medicare beneficiary without prescription drug coverage who has a pre-tax income of $18,000 a year or less and to couples with a combined income of $24,000 a year or less. Some 7 million Medicare enrollees will be eligible for the assistance, which will cover such commonly prescribed drugs as Aricept (for memory loss), Glucotrol (for diabetes), and Lipitor (for cholesterol). Seniors will be able to use their Share Cards — starting March 1 — at hundreds of pharmacies across the country, including CVS and Wal-Mart.

As generous as this is — and it is very generous — it is still only a partial, stop-gap solution. According to the General Accounting Office (GAO), the federal government auditing agency, Medicare recipients, on average, spend $69.54 per drug per month. And most, but not all, are taking multiple medications.

President Bush didn’t use time in his State of the Union address — which rightly focused on terrorism and the recession — to explain why prescription drug coverage wasn’t included in Medicare from the beginning. The simple answer is this: Few people realized at the time that America’s pharmaceutical companies would make the kind of dramatic advances they’ve made. Few people realized that this new cornucopia of miracle medicines would change the practice of medicine as it has. And few people realized how costly it would be to develop these medicines, though there were warnings, as the government’s approval process grew lengthier and more complicated.

But the President was right: As important as prescription drug coverage is to senior citizens — most of whom live on fixed incomes — it is not Medicare’s only problem. It is just one of many.

Put simply, Medicare and its paperwork is a nightmare: for doctors and hospitals, as well as seniors. All of the horror stories you have heard about HMOs are even more pronounced in the Medicare program: rules and regulations telling doctors what treatments are considered acceptable; rules and regulations limiting the frequency of doctor visits; limits on the amount Medicare will pay for certain services; paperwork coming out of the kazoo. You’d think some doctors would just wash their hands of the whole mess and stop seeing Medicare patients. And that’s exactly what’s happened.

What senior citizens need is what everyone else in America needs: the right and ability to choose both their physicians and their medical insurance plans. The Heritage Foundation has recommended such reforms, which enjoy bipartisan support in Congress. In fact, its plan would provide seniors with the same type of coverage that members of Congress have.Yes, we need prescription drug coverage. But it won’t fix Medicare. Fixing the larger problem will take courage and wisdom, two virtues that usually are in short supply in Washington when seniors issues are concerned.