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It All Depends

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If I were a senior contemplating what my Medicare and prescription drug coverage might be like when The Medicare Prescription Drug, Improvement and Modernization Act of 2003 starts to take effect, I think I would start stocking up on Depends. Now.

Id also probably look into hiring an accountant to take me through the shoals of a drug coverage plan so complicated that only our Congress could proudly claim responsibility for it.

Now why would I rush out to my nearest Sams Club and start clearing the shelves of Depends? The answer is simple but terrifying: I (as a senior) am being encouraged to trust myself to the mercy of the federal government and Medicare Health Maintenance Organizations.

Seniors are of a generation for which the old adage “Once bitten, twice shy” still means something. Many of them have been bitten by the two entitiesthe government and the Medicare HMOsthat they are now being asked and encouraged to trust.

Many are still bitter over the experience they had a few years ago when they signed up for what seemed like dream coverage with Medicare HMOs only to be left out to dry when funding from the government dried up.

Many HMOs, particularly in those states with hefty senior populations (think Florida) are holding a full court press to get seniors to sign up (or sign up again) for their Medicare coverage. Seniors are being treated to breakfast and all sorts of other good thingswith the hope that eventually they will sign on the dotted line. Theyre being told that this time around it will be different. And so it may appear.

The bill, after all, promises some hefty funding to Medicare HMOs in order to get them to sign upand keepseniors on the enrollment lists and thereby start to trim Medicare costs.

Feeling flush with this promised cash, Medicare HMOs are all but falling over themselves to get seniors on board. According to some reports, however, it has not been the easiest sell in the world. But who knows, it may be different this time around.

Yet, there always lurks the sneaking suspicion that what Congress giveth, Congress can taketh away. And in the facing of large budget deficits and their concomitant call for spending cuts, this looks like a pretty juicy target for Congress to taketh away.

So if I were a senior being besieged by tempting offers from health care entities that had disappointed (not to mention, jettisoned) me before, Id want to be very sure before I took another leap. Maybe even have them sign a promise in HMO blood.

Id also have a healthy dose of skepticism about the $400 billion in funding promised for prescription drugs over 10 years. No, wait a minute, its actually going to cost $534 billion, but we didnt find that out until after the bill was ever so narrowly passed in the House. Whatever the true amount is, its a lot of money.

Id have the same qualms about the certainty of this funding as I did about the Medicare HMOs funding. In other words, will it hold?

Its a lot of money for sure, but Id wonder if I was really going to save very much when Congress left out of the bill the governments strongest leverage with the drug companiesnamely the ability of the federal government to negotiate drug prices for the Medicare program. Seems like a windfall for the drug companies.

Id also wonder why the Congress would not allow me to buy supplemental drug coverage for that great big hole in the middle of the prescription drug donut they cooked up. They said they wanted seniors to be responsible regarding their drug purchases. Tell that to my arthritis!

Speaking of my arthritis, how about some responsibility from those drug companies the government cant negotiate with. I didnt need the Wall Street Journal to tell me that the price of Celebrex has gone up 23% since August 2001 (although thats where I read it last Wednesday).

Or that Lipitor has gone up 19% in the same time, as has Zoloft.

So Im just sitting here, thinking about how things are going to be under the new Medicare. Will it be better for me? .

Steve Piontek


Reproduced from National Underwriter Life & Health/Financial Services Edition, March 25, 2004. Copyright 2004 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.