In recent years, the greatest unmet need of older adults has been affordable prescription medicine. On average, Americans have been paying double what people in Canada and the European Union pay for the exact same prescriptions.
The extravagant price of medication in the United States has been due in no small part to bitter congressional gridlock over adding prescription drug coverage to Medicare, the health insurance program for Americans 65 and older or with serious disabilities. The long awaited launch this past January of a Medicare prescription drug benefit, then, should have been a moment of national pride and celebration. It was not.
The program, designed more in the interests of the drug and insurance industries and less in the public interest, is a bad deal. It needs an overhaul by Congress — and it needs an immediate extension of the May 15 deadline for enrollment.
Until the launch of the 2006 drug benefit, Medicare largely delivered its health coverage through a single-payer government financing agency that compensates doctors, nurses, therapists and hospitals for providing necessary and reasonable health care. The single-payer system has allowed Medicare to accomplish what President Lyndon Johnson promised it would do when he signed the program into law in 1965: Make life longer and better for more Americans.
Today, Medicare protects 43 million men and women, providing comprehensive health coverage accepted by nearly all doctors and hospitals. And in an era when government services are more often derided than praised, Medicare is the most respected and cost-efficient major health insurance program in the country. Its administrative costs are 3%, compared to the average 18% in administrative costs consumed by private health insurers.
But in creating the 2006 prescription drug program, Congress and the White House ignored what works in Medicare. They turned the drug benefit over to private, for-profit insurance companies — firms with an obligation to maximize profits, not serve the needs of older Americans.
Predictably, a chaotic and exploitative marketplace for consumers has emerged. Across the country, the oldest, frailest and most disabled Americans have been confronted with between 40 and 50 different drug plans from which to choose. The plans cover different drugs and are allowed to change the drugs they cover weekly, charge different premiums and deductibles, and impose an array of per-prescription costs — in some cases more than $100 per prescription.
Now, the Bush administration is insisting that any person with Medicare who does not enroll in a private drug plan by May 15 will be locked out of the benefit until 2007. And to boot, the administration will impose life-long premium penalties if these men and women later enroll in a drug plan.
Last week, a top administration official said that it lacks the legal authority to extend enrollment in the drug benefit past the May 15 deadline. That is simply wrong. The law gives the health and human services secretary ample authority to allow people to join a plan after May 15 and to allow people who enrolled in the wrong plan the opportunity to switch.
The secretary should exercise that authority. Extending the deadline is a matter of basic fairness and simple justice. No one predicted that 40, 50 or even 60 plans would join the gold rush and pose unsolvable puzzles to bewildered consumers. Few predicted that the alliance of private insurance companies and the Bush administration would fumble the rollout of the benefit as they did, prompting 35 states to launch emergency programs to bail out their poorest citizens — who were left helpless by the administration’s botched efforts.
All the while, high-pressure marketers continue to steer people with Medicare into drug plans that do not cover their drugs.
Health and Human Services Secretary Michael Leavitt’s refusal to extend the enrollment deadline shows an indifference to the anxiety of the people perplexed and intimidated by the radical new drug program. Leavitt’s own parents, who enrolled with great fanfare and with the secretary’s assistance last fall, joined a plan that jeopardized their own retiree health coverage.
Lucky for them, they caught their mistake in time and quit the plan. But what about everyone else? What would have happened if the Leavitts discovered their mistake after May 15?
Congress needs to step in. A majority of the Senate has voted to extend the May 15 deadline, but because of procedural rules, 60 votes were needed for passage. Now in an effort to get an up-or-down vote, 48 senators have signed a letter to Senate Majority Leader Bill Frist, Republican of Tennessee, urging him to bring the legislation to the floor. That bipartisan effort, led by Senator Bill Nelson, a Florida Democrat, and Senator Olympia Snowe, a Maine Republican, deserves support.
In the House, the Republican leadership is preventing any legislation to fix the drug benefit. However, a discharge petition sponsored by Democratic Reps. Pete Stark of California, Jan Schakowsky of Illinois and Marion Berry of Arkansas could force their hand. If a majority of House members sign that petition — the effort is currently only 31 votes short — the bill can come up for a vote on the House floor.
Congress must be allowed to vote. And voters should be prepared to ask their representatives in Congress how they are voting.