Opinion: Prescription problem for elderly

Despite the attention President Bush is giving to a prescription drug benefit under Medicare, the problem won't be easily solved. About a third of retirees -- 12-million people -- have no drug coverage. The president is adding $77-billion to his budget for prescription programs over the next 10 years, but that would reach no more than 3-million retirees. Even Republicans in Congress say a comprehensive drug benefit would cost at least $300-billion, but it's not clear where that money would come from.

Those aren't the only snags. Prescription costs have been rising and the drug companies are a powerful lobby that has resisted pressure to lower prices. Medicare HMOs that once lured retirees to their services by offering free prescriptions are backing away from that benefit because of rising costs. And some states that help low-income retirees with prescription drugs are finding it necessary to cut back.

Given such complex challenges, the president and Congress are on the right course by addressing the needs of the poorest Medicare recipients first. Too many elderly Americans must choose between paying for drugs and other needs, such as food and rent. One of those is Ellen Schneier, who is being treated for colon cancer at an HMO that stopped subsidizing drugs. "I don't know how I will be able to pay when I have chemotherapy again later this year," she told the New York Times. "I live minute to minute."

The new model for a drug benefit for the neediest Americans might be found in Illinois, where the Bush administration is supporting a test program. The federal government is giving the state $250-million over the next two years to expand prescriptions drug coverage for low-income Medicare recipients. Illinois' program currently pays for certain drugs for those at or below the poverty level. With the federal money, the state will be able to cover all drugs and to add recipients who find themselves slightly above the poverty level.

That is what Bush had in mind when he added $77-billion in his budget to supplement state drug programs. The federal money would pay 90 percent of the cost, making it appealing to states, but it is not clear the effort will reach anywhere near the target 3-million Medicare recipients. The main reason is that only half the states currently have such programs. Bush's effort will be judged on how successful it is in getting states to create prescription drug programs. (Florida retirees must meet strict income limits under the Medicaid program to get even a modest drug benefit.)

Of course, that leaves more than 90 percent of Medicare recipients still looking for an answer. Wealthy retirees who can afford Medigap insurance with drug coverage and those who retire with employee-sponsored drug benefits are the lucky ones. Sooner or later, the president and Congress will have to face the challenge of helping millions of retirees who aren't poor enough for subsidized programs or rich enough to buy all the drugs they need. The government will need the cooperation of the pharmaceutical industry to cut drug prices and a return to budget surpluses to pay the enormous cost. Those are far from sure things.

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