THE BUSH 'BENEFIT'
A Reality Check
by sonya hammond
The news that Medicare officials will soon be presenting retirees with details of Bush's much heralded prescription drug 'benefit' due to take effect next January should not be cause for undue celebration for anyone except possibly the nation's pharmaceutical companies whose prices will remain unrestrained, or the insurance industry that will provide the various plans. The rest of us should be prepared to educate ourselves on what has been termed by consumer advocates, in what may be the understatement of the year, a 'very very confusing benefit.' The word 'benefit' itself is a gross exaggeration.
To begin with, it will require some 42 million potential beneficiaries to make a series of decisions based on their ability to plow their way through pages of details written in the usual excruciatingly verbose governmentese. Surely the first clue that even the government recognizes the possibility that confusion may ensue is the news that they are launching a $300 million campaign to 'educate' us on our options.
Medicare Administrator Mark McClellan claims the plan represents a 'huge step' toward providing the elderly the help they need to pay for prescriptions, and the Congressional Budget Office [who would believe they had one?] estimates that enrollees will save about $465 on prescriptions the first year of the plan. How they arrived at that figure is anybody's guess, but this administration's ability to shrink financial mountains and enlarge fiscal molehills is legendary.
For those of us less adept at creative budget projections, any ideas that prescription drug relief is on the way will be immediately laid to rest once a little mundane math injects a few mgs of reality into the details of this 'benefit.' As a case in point, I present actual figures based on how my own drug costs would be affected if I enroll in the new plan next year.
Last year, after several months research on the Internet for the best deals I could find from either pharmaceutical companies themselves, or prescription drug cards offering discounts, I was able to bring my annual drug costs down to $708.60, based on my income qualifying me for 3 different cards for 6 drugs, and 3 free drugs direct from drug company plans. Without the cards or free drugs, I would be paying $5,066.04 a year for the 9 drugs I currently need, a cost I simply could not afford.
Many, if not all, of the discounts I am now receiving will probably disappear next year when the new MC benefit goes into effect. (My income is not low enough to qualify me as a 'poor beneficiary' under MC guidelines.) Presuming that this happens, and that I enroll in the MC plan, I would pay an annual premium of $420 ($35 a month.) After I pay an annual $250 deductible, MC would pay 75% of the first $2,000 of my costs, or $1500.
Based on my estimated costs of $5,066.04 for the year, and after MC's $1500 payment, I would be left with $3,566.04 of uncovered costs [including my $250 deductible.] Adding to that my annual premium of $420, I would end up paying $3,986.04 for the 9 drugs for which I now pay $708.60, in other words, $3,277.44 MORE under MC's prescription drug benefit plan.
Right now I'm saving $4,357.44. Next year I could be losing $3,277.04, since in its wisdom MC will provide no coverage for expenses between $2,250-$5,100 ... an omission termed the 'doughnut hole,' possibly in a misguided attempt to make the irrational sound more appetizing. Should I acquire any new diseases that push my expenses over $5,100, they will pay 95% of those, apparently on the theory that a limited number of us will make it that far.
I realize that not every potential beneficiary has either the time or the ability to dig out the discount offers that might be currently available, and for them the MC benefit may offer some minimal savings. And for those with very low incomes, the plan apparently can offer true benefits. But for most of us, it will be difficult to obtain even the basic information needed to make informed choices among a plethora of plans all providing different drug benefits, let alone to get any real relief from our rising costs.
Of course, I don't have to take the MC benefit, but if I don't, and I lose all my current discounts, I would be in the hole $5,000+, so the $3,277.44 bill could be considered the lesser of two evils. As a further incentive, Medicare, for whom 'care' has less meaning every year, warns that those of us who fail to join up this fall will face higher premiums if we decide to sign up later.
My other option is to be cured of several diseases that necessitate my taking drugs in the first place. The bad news is that they are all currently on the 'incurable' list. The good news is that $5,066.04 worth of drugs may keep me ... and all that legendary pharmaceutical research ... going.
There is, of course, a third option. As MASH's theme song put it ... 'Suicide is Painless.' Unfortunately, I don't think the Oregon right-to-die law guidelines include inability to pay for drugs, so any way you look at it, I'll be on my own. Which is pretty much where the Bush Administration plans to put all of us. Next stop, Social Security.
©sonya hammond, 2005