22 August 2008

Death by Donut Hole! - Part D's a killer!

Two years ago, this September 6th, I joined with hundreds of other activists in Washington, D.C., to deliver donut holes to congressional and senate offices in protest of the Medicare drug plan’s (Part D) “donut hole”.

We knew, and we warned then, that the drug and insurance company written plan, enacted by a republican congress, and signed by Bush, and blessed as “the best we can get” by AARP, was no more than a drug and insurance company boondoggle on seniors, and an unmitigated disaster waiting to happen.

September is an especially critical time for seniors because that is the month when millions of them slide into the “donut hole” or Part D coverage gap. Here’s how that works--or doesn't work, depending on your viewpoint. At last year’s rate, Medicare beneficiaries are on the hook for full payment of prescription drugs after they incur costs of $2,400 with a Part D, private insurer. That’s right, the insured senior continues to pay premiums, but has no coverage, until he or she has spent $3,850 out-of-pocket, then the coverage resumes.

The obvious disaster waiting to happen has happened. Older Americans, after falling into the gap, are giving up their medicines, and risking their fragile health and their lives.

Yesterday, the Kaiser Foundation released the results of a joint research project with the University of Chicago and Georgetown University, confirming that seniors entering the “donut hole” give up critical, life-supporting medications because of cost. Kaiser Report Online

About 3.4-million older Americans fell into that gap last year, according to the Kaiser Family Foundation’s report. Once there, they stay there. The average senior reaching the gap received less than one month of “catastrophic coverage” (when coverage kicks in again after the $3,850 out-of-pocket). What this very clearly means, is that more than a half-million older Americans did without critical medications last year due to higher costs after falling into the “donut hole”. Simply put: Fifteen percent of those falling into the gap stopped their treatment regimen due to high costs!

Alzheimer patients (8%) were the least likely to give up their medicines. But, a frightening 16% gave up their high blood pressure medicines, and 10% of diabetes patients stopped buying their medicines. Others with painful chronic, but not life-threatening, illnesses had much higher rates as 18% of patients with osteoporosis, and 20% of patients suffering from ulcers or acid reflux stopped buying their pain and condition palliative medicines.

The report does not project the number of deaths, impairments, and worsening of conditions from the discontinuance of those critical medications by seniors. But, it is not difficult to suppose that some occurred as a result. That tragedy belongs to congress, Bush, the drug and insurance companies, and AARP who rolled-over on “Part D”.

Nor does it tell the story of the Bush administration's insistance on prohibiting, by criminalizing, Medicare's ability to bid for lower drug costs.

Looking ahead, according to a report by the Associated Press, the averageMedicare Part D beneficiary will face a 12% monthly premium increase in 2009. Federal government projections show the cost of standard drug coverage rising $3 to $28 each month. The estimate was based on bids from the private insurance companies administering the plans, and the increase is due largely to higher drug costs and a larger number of prescriptions per person, according to Medicare officials.

The solution is quiet simple, very doable, and should become the first order of business for the next congress. Allow Medicare, already proven to be a cost-efficient administrator of health care, to take bids for drugs and buy in bulk as does the Veteran’s Administration. The savings from this would enable the closing of the “coverage gap” and save lives. Failure to do so will be a death sentence for many Older Americans as drug-price and coverage premium increases quicken their slide into a gap which is rapidely becoming a yawning grave!

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