Medicare Part D a big headache

Your Feb. 7 editorial saying that the Medicare drug plan (Part D) will need changes was an understatement. In 2003, when the Bush administration proposed a prescription drug program, promises were made that this would be the solution to the skyrocketing costs of prescription drugs. The bill was fast-tracked through the Republican Congress in time for the 2004 elections. The program, Medicare Part D, now is being implemented, and it's clear that the main beneficiaries have not been the 43 million seniors, including 184,000 in Hawaii, who are eligible, but the pharmaceutical companies and the private insurance industry.

What's wrong with Part D? You first have to figure out if it even makes sense to enroll given the different levels of payment, including the infamous "doughnut hole" -- the lack of coverage between $2,850 and $5,100 in prescription costs. Then, according to the Medicare Web site, you have to choose among 12 companies offering 29 different plans with premiums ranging from $17.48 to $64.43, deductibles from $0 to $250, and coverage of the top 100 prescribed drugs from a low of 78 to a high of 100. (See www.medicare.gov/medicareform/map.asp)

OK, maybe after figuring this all out, you want to help your grandmother in Wisconsin enroll. Think again. They have 18 companies offering 45 plans with different premiums, deductibles, copays and drugs covered. And it's different everywhere else in the country. Oh, and you have until May 15 to decide what to do or you have to pay more for every month you delay enrolling.

President Bush has said that Part D is "a good deal for seniors" and believes that having choices lowers costs. Unfortunately, this is not true. The law expressly prohibits the federal government from negotiating with drug companies for lower prices for the Part D program, something that currently is done for other federal agencies such as the Department of Veterans Affairs. According to Families USA, the result has been that of the 20 most common drugs for seniors, the difference between the VA and Part D is 48 percent. Take Protonix for your ulcers? The VA pays $253 for a year's supply. Part D? You'll pay $1,080. Take Zocor for high cholesterol? The VA price is $251; Part D, $1,323. It's easy to see why the drug industry supported the program. Despite the potential bulk purchasing power of 43 million Medicare consumers, they still end up paying the retail price of drugs.

Furthermore, according to the Congressional Budget Office, by 2015, Part D will balloon to almost one-fourth of the entire spending on Medicare, a level that is clearly unsustainable in the long term.

What to do? At a minimum, Congress should acknowledge that the program was ill conceived and poorly implemented, and move quickly to:

» eliminate the penalty for all Medicare eligible individuals who do not enroll by May 15, 2006;

» standardize plans to ensure the same number of tiers and requirements for coverage;

» ensure transparency so that states know the cost negotiated by the prescription drug plan to ensure that all negotiated rebates are passed through to the beneficiaries; and

» institute price negotiation for the purchase of prescription drugs for the Medicare program, similar to the provisions already in place under Medicaid and the VA.

The goal of any effort to lower the cost of prescription drugs should be to offer the greatest benefit to as many people as possible. It should never be about protecting industry profit margins over improving the health of the most vulnerable in our community.

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