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Mary Pitt: The Great Medicare Maze

The Great Medicare Maze

by Mary Pitt

If you have never seen a riddle in an enigma, wrapped in a conundrum, just log into the Medicare or the AARP site and try to figure out the plans for Medicare, Part D. Now, this is not to be confused in any way with Medicare as we know it. Gone is the "single-payer" program. This is nothing more nor less than a mandatory requirement to engage in commerce with the regularly licensed insurance companies with which we are all too familiar.

First, you are not only required to know what medications you are currently taking, but you must predict what medications you might possibly require later in life. Some companies may refuse to pay for one medicine but will cover another. Your job will be to carry with you the list of covered medications every time you see a doctor or check into an emergency room so that your physician will not prescribe a non-covered drug. Some companies will waive the deductible while charging a higher co-payment. Others base the co-payment schedule on the medication used. If you have prescriptions for "generic" drugs, you may pay less than for a "brand name" medication. Others have a "tier" system whereby you pay a higher co-pay for some drugs than for others, and some are only usable in their chain system of pharmacies, requiring one to have to go some distance away to obtain their prescriptions. Many of the medications commonly prescribed by doctors will not be covered at all!

It has been stated that use of generic drugs will save money for the company issuing the insurance, but that sometimes has drawbacks which a patient is not able to tolerate. A good example is the difference between the blood-thinner, Coumadin, and its generic "cousin", Warfarin. Cumadin is what is called a "stable dosage" medication, which means that each tablet will have the same dosage of the essential ingredient as the others. This creates a steady control of the desired activity in the system. On the other hand, Warafin is known as an "unstable dosage" medication in that the tablets may vary in strength and allow the clotting effect to be variable, possibly contributing to either stroke or uncontrolled internal bleeding. Other "generic" drugs may have side-effects that may be similar if not so serious. In many cases, something as simple as a reaction to one of the "inert" ingredients, used to contain or to stabilize the essential ingredients, may jeoparize the life of the patient, requiring a switch to a different brand, which may or may not be included in your insurance company's "pharmacoepia".

Even with the handy-dandy little "help tools" which are furnished by the government, the AARP, and the insurance companies, it is simply impossible for the private citizen, especially the elderly who are supposed to benefit by it, to compute the financial impact on their budget. One must simply consult all those advisors who are willing to help and then reach into the grab-bag and pull out an insurance company which will control your health until you are moved to reach back into the bag and choose another, but not until after you have to deal with the shortfall with which you are faced as the result of the policies of the first company.

In addition, you have the option to have the premiums deducted from your Social Security check. That way the insurance company will get their money before you get yours, and you will be left with less total income and still have the deductibles and co-payments with which to contend. Bear in mind that with the "cost-of living" increase, there is also an increase in the premiums for Medicare and for Part B which will leave most beneficiaries with slightly less in their check this year even before the Part D premiums are taken out. Thus, rather than an increase in Social Security benefits for the year, the elderly are facing a reduction in their disposable income and many will be left with even greater bills than before for their medical care.

Those who have been eligible for Medicaid and have had their Part B premiums paid for and little or no co-payments with which to deal, are finding themselves faced with paying the deductibles and co-payments inflicted by this "insurance" coverage and will be less able than before to afford medical care. In addition we must consider the reduction in LIHEAPP funds and the increase in fuel prices. We will hear no more about people who have to choose between keeping warm or staying healthy. They will be able to do neither! Medicaid beneficiaries who have not signed with a company by now will find that they have already been "enrolled" with a company that has been designated by their state and will have no choice but to complete their research and go through the process of changing, should such action benefit them. In the meantime, they may be tasked with finding transportation to distant drug stores in order to obtain their medicines. The rest of us have a few more months before we must enroll before being penalized, unless Congress acts in the meantime to simplify, defer, or repeal this blunderbus of a "program" with which we are afflicted.

This is but the latest boondoggle to bleed the limited resources of the poor, the weak, and the elderly to the benefit of the corporate moguls. If one dares to mention the possibility and the advantages of single-payer health care based on the pattern currently employed by Medicare, one is lambasted with charges of wanting "socialized medicine" and "rationed Medical care", but these charges are spurious. It would cover only the essential services and doctor-prescribed necessary medications, leaving things like "elective surgery" such as face-lifts and tummy-tucks to be paid by the patient and drugs like Viagra to be paid out-of-pocket as would be other "recreational" items.

The United States spends a greater amount for medical care than any other nation in the world but does not have the highest quality of care by far. This can be partially accounted for by the unconscionable prices of prescription drugs, but also by the exhorbitant premiums charged for health insurance. The costs for health insurance of employees has broken many American manufacturing corporations and left uncounted persons unable to provide the basics of health care for their families. The insurance companies merely raise the rates charged to those who can still afford to pay and continue to show record profits as their owners pocket ever-expanding dividends.

As a couple who are eligible for Medicare Part D, we find ouselves sifting through insurance company advertising in our mail on a daily basis, each offering the limitless sky and each adding to the confusion over choice. This leads one to believe that they have been given a bonanza by the passage of this undecypherable legislation and there is no way the American public can participate on an equal basis with their corporate gobbledegook. It is merely another bone thrown to the corporate dogs in order to assure the continuation of the river of campaign funds flowing into the political parties. I charge the "compassionate conservatives" for further victimizing the American public and the "party-of-the-people" Democrats for allowing this travesty of an "insurance program" to pass out of Congresss and onto the backs of those who have already been reduced to pauperhood and who find their meager income looted once again.

God save America!


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