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Special coverage: Medicare

It's time for seniors to be aggressive

By FRANK KAISER
Published April 25, 2006

Every day I get between 35 and 75 e-mails from readers complaining about the new Medicare Plan D. And every day, after reading and answering this e-mail, I'm so furious that, to simmer down, I must go for a long walk or a hard swim.

This may be good for my health, but not for our country. Plan D's red tape has most readers hog-tied. The insurance companies have more ways to restrict access to needed medicine than the drug companies have alibis for raising prices.

Insurance company-set dosage and quantity limits below prescribed measures leave patients struggling to learn if their dose is even effective.

Required "prior authorization" stops many people from taking drugs their doctors deem vital for chronic conditions.

Others, searching for the cheapest place at which they are authorized to buy their drugs, run smack into the "price paradox," one of many Catch-22s of Plan D. So-called "preferred" pharmacies will not provide price quotes without actually filling the prescription.

Meanwhile, patient assistance programs that provided millions of lower-income seniors with cheap or even free medicine have dried up, the drugmakers claiming that such life-saving measures are no longer needed because of Plan D.

People are told their names are "not in the system." Codes don't work. Literally hundreds of Suddenly Senior readers have told me they have yet to get any medicine from the private insurance provider they selected. Most often, these poor folks can't even get a human being at their new insurance companies to talk to them.

Of course, this would be just another government folly if the consequences weren't so dire. For many seniors, it seems that our health system has been turned over to trolls interested only in their growing pots of gold.

But we knew that in 2003 when the drug bill passed.

Written by Big Pharma, this new law prohibited Medicare staffers from bargaining for cheaper drug prices - as the Department of Veterans Affairs does so successfully. In fact, Plan D prohibited Medicare from having anything to do with it, putting the drug program under the thumbs of the insurance trolls instead.

Seniors aren't dumb, just passive

Then Congress lied to us. The president lied to us. The AARP lied to us. Everyone in Washington told us this was best benefit since free air.

These folks must believe we seniors are dumber than dust bunnies.

But you know, we're not as dumb as we are passive. Although we knew we were getting a lousy deal - that under Plan D, our grandchildren would still be faced with deficits in the hundreds of billions of dollars - we still would have gone along with the program, doughnut hole and all, if the insurance companies hadn't resisted giving back anything in return for this new "stream of revenue.''

From the beginning, these companies worked to bamboozle us with different monthly premiums, different drug formularies, different co-payments for our medications, different benefit levels, exceptions and terms that simply couldn't be compared by even a careful consumer.

The Alliance for Retired Americans says, "If Medicare were allowed to negotiate drug prices directly with the pharmaceutical industry, and if Medicare offered the drug benefit directly rather than private insurers, the combined savings would be more than $600-billion from 2006 to 2013."

The alliance urges Congress to enact legislation to improve the Medicare Part D Rx Drug Program for the estimated 43-million Medicare beneficiaries. Improvements should include the following:

-- Repeal the prohibition against the federal government negotiating drug prices on behalf of the all Medicare beneficiaries - essential to reducing the overall cost of the program, and to prevent windfall profits to drug companies.

-- Use those drug-price savings to fill the so-called "doughnut hole" or gap in coverage between $2,250 and $5,100 in drug costs to consumers.

-- Eliminate the asset test for low-income recipients to receive the extra help.

-- Eliminate or delay the penalty for late enrollment in the program.

-- Allow Americans to purchase drugs from Canada and other countries with quality standards.

Instead of choice, the federal government gave us chaos - muddled even more by numerous price and formulary changes.

So I'm not surprised that I get dozens of e-mails daily from seniors exasperated by the wanton gall of it all.

It is my sense that seniors are "mad as hell and aren't going to take it anymore."

We may be the only ones around who still remember what democracy is all about. Come November, we plan to teach you all a lesson in government of, by and, especially, for the people.

Frank Kaiser is a nationally syndicated columnist who lives in Clearwater. His Web site, www.suddenlysenior.com, includes nostalgia, trivia, senior humor and 111 Best Senior Links. Write Frank c/o Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731, or e-mail features@sptimes.com

[Last modified April 25, 2006, 15:50:00]