Drug plans and real people
By KRIS HUNDLEY
© St. Petersburg Times, published October 15, 2000
Subsidizing drug costs for Medicare recipients is a pivotal issue in the presidential election.
Both Al Gore and George W. Bush have cited heart-tugging cases of elderly Americans forced to choose between food and life-saving prescriptions. Both have pledged to use the riches of our booming economy to remedy the situation. And both have attacked their opponent's prescription drug plan as inadequate, unrealistic and, even worse, an HMO in disguise.
It's enough to make you want to take a pill.
In an effort to understand how real people would be affected by each of the candidate's proposals, the ST. PETERSBURG TIMES interviewed five local residents about their personal situations.
What becomes obvious immediately is that the little old lady who is forced to buy cat food so she can pay for her Prozac is the exception, not the rule. Medicare estimates that the average beneficiary spends about $670 per year on prescription drugs -- less than $60 per month. Only about 7 percent spend more than $2,000 per year on drugs. And though Medicare does not currently cover prescription drugs, more than two-thirds of beneficiaries already have some coverage for prescriptions, either through a retiree program or a Medicare HMO.
What also becomes clear after listening to seniors is that while many support a plan for prescription assistance, that view is far from unanimous.
Margaret Sacco is a 72-year-old retired nurse in New Port Richey. Her husband is 82 and a retired New York City police officer. They pay $200 out of pocket every month for drugs and Sacco thinks that's only fair.
"If the drug plan is attached to Medicare, and given to all people, the workers of today are going to have to pay a big premium on their Social Security benefits," said Sacco, who worries about the tax load on her two adult children. "And you probably will never see them for yourself when you retire."
But voices like Sacco's are being drowned out as the presidential candidates try to one-up each other over their concern for seniors. Some kind of prescription benefit may be inevitable; what form it will take is far from certain.
There are plenty of unknowns in both plans. Bush's plan, for instance, would rely on private insurers, but the types of drug coverage they would offer and the amount of monthly premium is not known. Another big question: Would insurers who have been abandoning Medicare HMOs the minute they become money-losers be willing to step forward with drug plans?
Here's our best projection of how a half-dozen local residents would fare, as well as their own thoughts on the prescription drug quandry.
Addie Barrett, Tarpon Springs
Occupation: Registered nurse, retired with disability in 1985
Monthly income: $1,000 from Social Security and pension
Monthly prescription drug expense: $600
Under Gore plan: The government would pay part of Barrett's $25 monthly premium and half of her first $2,000 in drug costs. Once Barrett spends $4,000 out of pocket on drugs -- probably by September -- the goverment would pay the rest.
Under Bush plan: The government would pay more than 25 percent of her premium for a prescription drug plan. Once Barrett spent $6,000 on any health-related expense, the government would pay all other costs.
"Right now I'm on Humana's HMO, which has a $1,000 cap on branded drugs. I reached that in August, so now I'm paying full price for my drugs. And I was just told that the HMO's premium is going up to $179 per month next year. If I have to pay that, plus my medication, something's got to give.
"I have friends that will help me if I need it because it really hurts to have to go to these agencies and ask for help. I had some savings, but I've used that up.
"I'm not afraid of getting old, it's just getting old and handicapped."
Ed and Jean Frasso, Tierra Verde
Age: Ed, 75; Jean, 72
Occupation: previously owned interior design/lighting business
Monthly income: $10,000
Monthly prescription drug costs: $300
Under Gore plan: Frassos would each pay $25 monthly premium, then the government would pick up half their prescription costs. With their current prescriptions, they should not reach the $2,000 per person limit on the government match. Should that change, however, and either of the couple spends $4,000 per year out of pocket on drugs, the government will pay the rest.
Under Bush plan: The government would pay 25 percent of an HMO policy offering prescription drugs and pick up all costs after either Frasso spends $6,000 per year on medical expenses.
"We're on Medicare with a supplemental policy but we have no prescription coverage. But I'm not looking for the government to take care of my prescription drugs. I'm totally against all these government payouts. I realize some people are having problems with their prescription drug situation, but we can't have the government taking us from womb to grave. If they want to give us some adjustment, they can give us relief on income tax. Right now I have to have $7,500 in medical expenses before I get a tax break. Why not reduce that amount?
"I've been fortunate, but I worked my butt off all my life. Many times I could have spent the money, but I was a little more frugal, saving for my retirement. I can't see other people continually being on the take.
"This is just another gimmick to look for votes. It's another way for the government to spill red ink all over me and the budget."
Mimi Gewanter, St. Pete Beach
Occupation: retired librarian
Monthly income: $2,393
Monthly prescription drug expense: $34
Under Gore plan: Gewanter would pay $25 per month in premium, then government would pay half her prescription expenses, about $17 per month. With her current prescriptions, she would not reach the limit on government match. However, if her out-of-pocket drug costs increase to $4,000 per year, the government could pick up remaining costs.
Under Bush plan: Government would pay 25 percent of her HMO drug coverage. The government would pick up any medical bills should she spend $6,000 on health-related medical expenses in a year.
"I don't like the Gore plan because you would only have one opportunity to sign up for it. If you don't sign up for it now, it's lost. But I don't need it now. And why would I want to pay for it if I don't need it?
"My husband's prescription drugs cost more than mine. They run almost $3,000 a year. But under the Gore and Bush plans, I would have to subsidize his prescription costs and I don't want to subsidize anybody.
"I came from Romania in 1971. I came from a Communist country and I don't want to see socialism in this wonderful country and that's where we're heading. And I don't want to hear about HMOs. I wouldn't take an HMO for nothing."
Jeanette Sweetser, Hudson
Occupation: retired hospital accounts manager
Monthly income: $2,327
Monthly prescription drug expense: $700
Under Gore plan: Sweetser would pay $25 per month premium. The government would pay half of the first $2,000 in drug costs. After Sweetser has paid $4,000 for drugs, the government would pay the rest.
Under Bush plan: The government would pay 25 percent of Sweetser's premium for an HMO prescription plan. Once she pays out $6,000 in medical bills per year, the government would pick up all other health-related costs.
"I take 16 different prescriptions, over 30 pills a day. I'm a buffet. I've had doctors who start out by saying I'm taking too many pills and by the time they're finished with me, I have even more. I wish they could give me one big pill, and a cheap one too.
"My husband, who's 57, works two jobs, so we're not poor enough and we're not rich enough. When I first got sick, trying to handle the cost of these drugs, I ran up credit cards so big I had to go bankrupt.
"I've called pharmaceutical companies, asking for help, but they gave me nothing. And not all doctors are that generous with samples. I had a prescription for gout medicine and went about six months without it. What do you do when you don't have the money?"
Betty Honig, St. Petersburg
Occupation: retired state worker
Monthly income: $1,275
Monthly prescription drug expense: zero
Under Gore plan: Honig, like all Medicare beneficiaries, would have the choice to opt out of the drug plan since she has no drug costs. If she chose the plan, she would pay $25 per month and half of her first $2,000 in prescription costs. If she spent more than $4,000 on drugs per year, the government would pay the rest.
Under Bush plan: The government would pay more than 25 percent of Honig's premium, if she chose to become involved in the program. It would also pay all expenses after Honig spent $6,000 in a year on medical costs.
"I haven't taken so much as an aspirin in 18 years and I don't even have a medicine cabinet. I'm not saying I'm not grateful for certain good genes, but from the time I was 18, I took charge of my life with a sensible diet. I walk and I bike and I've never had any health problems. If the doctor tried to prescribe a drug to me I'd say, "No way, baby.'
"Why don't we try to attack these health problems from a preventative standpoint, rather than with drugs? It just annoys me to think of all this money going into a hole.
"I'm on a Medicare HMO, but I only go to the doctor once a year because they tell me to. Actually I'm paying quite a bit in premiums for absolutely nothing.
"It rankles me a bit to feel like I'm paying to subsidize drugs for other people and yet I feel for them. They're in a fix they cannot correct. I don't know of anyone who doesn't spend hundreds of dollars every month for drugs. I don't know how they do it."
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