Joanna Chao

Grant Hier

Writing 39C

10. June 2004

What Should Be Done to Help America’s Seniors?

Through her first hand encounters with co-workers who did not have any, much less adequate, healthcare coverage, Barbara Ehrenreich draws attention to this growing dilemma among the working class in America in her book, Nickel and Dimed.  Although the issue of healthcare specifically for the elderly is not addressed, they face the same dilemmas of “going without routine care or prescription drugs and end up paying the price” (27) as those in the working class.  According to the “Population Projections by Age” published by the U.S. Census Bureau, between the years 2000 and 2010, the population of baby boomers are rising and reaching retirement age (U.S. Census Bureau, No. 36).  In turn, most of these people will cease to earn a steady income, become eligible for Medicare health coverage, and will begin to collect social security checks.  According to the Economic Policy Institute, a popular non-profit, nonpartisan think tank which seeks to come up with strategies or resolutions to achieve a successful economy, their “Retirement Security Facts at a Glance” reports that social security merely accounts for 41-47% of a worker’s needed income, translating to approximately half of what is needed (par. 2).  At this rate, it is difficult for seniors to afford the out-of-pocket expenses of health coverage.  According to the most updated U.S. Census Bureau’s report in 2001, an estimate of 14.6 percent of the population have been without health coverage that past year.  This translates into 41.2 million people who do not have a means of getting the health treatment they need for survival, and this number is growing (Health Insurance Coverage: 2001 by U.S. Census Bureau, par. 1).  Medicare provides healthcare coverage for most Americans ages 65 or older and some disabled before retirement age.  My phone call to Kaiser Permanente was directed to the admitting department.  Per my conversation with Virginia Graverly, she said that many people call the office trying to find out what procedures are covered by their insurances, and how much of their prescription cost will be covered.  I asked her to comment on the matter and she said, “Medicare coverage, you know, it’s really not enough for what these people need to have treated.”  Something must be done about the current Medicare policy, but what exactly?  In the areas of consideration are health coverage and accessibility, prescription drug benefits, and preventative care, John Edwards’ “Agenda and Record on Seniors” (ARS) is the better proposal compared to Kerry’s “Four Step Plan to Restore Medicare” (FSPRM) and Bush’s “Framework to Modernize and Improve Medicare Fact Sheet” (FMIMFS) because it has wider coverage which aims to be accessible to seniors in rural areas, advocates cheaper generic prescription drugs for affordability, and although Edwards does not directly address preventative care, proposes to make high-tech computer technology and medical care available to make it possible for effective treatment.  In the area of coverage, Bush and Kerry’s plans are weak because it only focuses on current beneficiaries rather than extending the service to all qualified seniors.  While Kerry’s plan advocates reimporting generic drugs from Canada like Edwards’ plan, Bush’s (FMIMFS) plan is more singular in its focus to protecting the job market in the pharmaceutical industry by limiting resource options, making a drug discount card available for drugs in the United States.  Edwards’ ARS takes a step further to address technology to be used for preventative care, which Bush and Kerry skim the surface to say that preventative care is needed but lacks the tools to put it into action.  Therefore, Edwards’ ARS is the best and complete plan to reform the current Medicare.

It is important to understand the provisions of Medicare today in order to know what 2004 presidential candidates John Edwards, John Kerry, and George W. Bush are proposing to change or improve in the system.  According to the 2003 Medicare handbook, the health plan is divided into part A and part B.  Part A provides eligibility coverage for almost everyone over 65 years of age.  Those who are not eligible have the option to pay a monthly premium of $316 ($174 for persons who have at least 30 quarters of covered employment) to gain coverage.  Part B on the other hand, is optional for a monthly premium of $58.70 in 2003.  This coverage applies only to inpatient hospital care visits.  The benefits for part A in 2003 are as follows: The first 60 days of inpatient HI services in a benefit period are subject to a deductible of $840 upon entering the hospital and ends when they have not been in a hospital or a skilled nursing facility for 60 days. Those patients who need coverage after 60 days are then subject to additional charges.  Part B provides laboratory, physicians, and medical equipment services, paying 80 percent of approved services leaving the beneficiary to pay for the $100 deductible and the 20 percent balance (Medicare Handbook, section 2).

Undoubtedly, the cost of drug coverage still remains a major burden on the minds of seniors who are barely “getting by” with the little amount of money provided by social security.  Steps two and four in John Kerry’s “Four-Step Plan to Restore Medicare” (FSPRM) proposes that seniors should be able to choose their doctors, and be provided with the adequate care they deserve rather than having to resort to joining an HMO merely because this will give them better drug coverage (Kerry, par 3)

Scheduled to be implemented within the first 100 days of his presidency, Kerry’s proposal is important in giving seniors better coverage under the current Medicare with adequate prescription drug allowance as well as the care they need, giving them the flexibility to choose an adequate healthcare without compromising either benefit.  People in general would be more comfortable being treated by a doctor who is familiar with their medical history and has already established an interpersonal relationship with the patient.  Similarly, Bush’s “Framework to Modernize and Improve Medicare Fact Sheet” (FMIMFS) proposes to give all Medicare beneficiaries the “choice of the doctor, hospital or place they want treatment and care they need” as well as “prescription drug coverage that enables seniors to get the medicines they need, without the government dictating their drug choices” (par. 7).  Both Bush and Kerry’s proposals are good-natured and promising in the sense that they seek to upgrade the current Medicare policy, but they fail to acknowledge that approximately 25% of seniors who live in rural areas (U.S. Census Bureau, No. 36) and may not be getting the basic medical attention as outlined by Medicare, and according to Edwards, a former doctor, merely 9% of physicians practice in these areas (Edwards, par. 5).  What is important to understand is the foundation that Edwards is trying to establish in his “Agenda and Record on Seniors” (ARS).  His proposal focuses on extending total coverage for seniors everywhere.  Assuming that the current Medicare is inadequate and modifications need to be made, it is important, at the very basic level, to extend it to all seniors.  Rather than disregard those who live in rural areas, Edwards’ ARS is inclusive, and gives them some form of healthcare at least, which must be implemented before modifications can be made to the current Medicare coverage and is therefore the most promising healthcare proposal.  Furthermore, this foundation proposed in Edwards’ ARS is figuratively taking into account a panoramic view of the lack of healthcare and solving that problem first, making it more evaluative and comprehensive.  Contrary to that, Bush and Kerry’s are taking a nosedive approach to help existing beneficiaries without looking at the broader scope as an aim to extend the opportunity to all seniors, making their proposals weak and ineffective in comparison to Edwards’.

Based on attached Table 2-4, “Part A and Part B Deductible, Coinsurance, and Premiums, Selected Years 1966-2003,” the cost of Medicare coverage has drastically risen from a mere $40 in 1966 to an astounding $840 in 2003 just for an inpatient hospital care deductible.  If patients deal with the high cost of healthcare coverage, it is hard to surmise how much more stress is placed upon them to worry about the cost of prescription drugs.  When a patient sees his/her doctor for an illness and a prescription drug treatment is prescribed but s/he cannot afford it, this patient will feel that s/he has run out of options.  It would be pointless for a patient to be diagnosed with pneumonia for example, and have to leave it at that because they don’t have the money to spend on the prescription given by the doctor to treat the illness.  In this way, the patient will feel more inclined to join an HMO healthcare provider, just because they know that they will get better drug coverage.  Perhaps an HMO has better drug coverage, but their doctors may not be familiar with the medical history of the patient, and treats very general cases.  Furthermore, because the doctor is not familiar with the patient, they may not prescribe the most effective medication to treat the illness.  Seniors should not be faced with the decision to compromise the diagnosis or the treatment needed to get better. 

Edwards’ ARS proposes to allow safe importation of prescription drugs from Canada (Edwards, par. 4), making treatments more accessible to seniors who deal with the high out-of-pocket costs of prescription medication, giving them the freedom to stay with their current Medicare provider.  In the graph below created by the AARP, the average annual percentage change in manufacturer prices for most widely used brand name prescription drugs between the years 2000 and 2003 has risen an astounding 4.1 percent (AARP, figure 1). 

Accessibility to generic drugs is important in preventing seniors from being stripped of their financial viability.  It is ridiculous for seniors to pay for the pharmaceutical company’s “brand name” to be printed on the drug if the same exact product/formula is sold at a cheaper price just without the name.  By allowing the reimportation of lower priced Canadian drugs, this gives a patient the freedom to obtain what they need as well as the option to choose where they want to get the prescription.  Similarly, Kerry’s “Plan to Lower Prescription Drug Prices for Seniors” (PLPDPS) proposes to “allow individuals, pharmacists, wholesalers and distributors to reimport FDA-approved prescription drugs from other countries at lower prices” (Kerry PLPDPS, par. 3).  Kerry’s plan to implement FDA-safe importation within the first hundred days of being in office if he wins, gives a far more in-depth explanation of what should be done to make it happen, proposing that the FDA Commissioner should “provide guidance to states to help assure they set up a safe process—including a state-sanctioned website, a call number, and helping define necessary safety precautions” (Kerry PLPDPS, par. 3) for all drugs across the United States.  By outlining exactly what steps need to be taken to execute his plan, Kerry’s proposal possesses the same intents as Edwards’, but is a step up from Edwards’ plan which merely suggests that drugs should be allowed to be reimported, but does not specify what should be done to make it feasible.  Rather than allowing reimportation of prescription drugs as proposed by Kerry and Edwards, Bush has a different goal in mind.  Understandably, Bush’s FMIMFS appears to be protecting the pharmaceutical industry and the job market in the United States by not forcing them to lower their prices nor does he encourage seniors to buy generic brand drugs instead of the brand name ones.  Rather, he proposes immediate discounts for all seniors by “provid[ing] all seniors with a drug discount card that is estimated to achieve savings of 10-25 percent on the cost of prescription drugs by pooling the buying power of Medicare participants” (Bush, par. 15).  Bush may be eager to give seniors the much needed discount through his proposal, but according to the Centers for Medicare & Medicaid Services (CMS), “the discount card is intended as a temporary program” before a “comprehensive prescription drug benefit [is scheduled to] begin January 1, 2006” (par. 5) which will give seniors limited benefits.  However, seniors who need long term medication/ treatments should not be cut-off when this temporary program is over.  Critics may argue that the comprehensive prescription drug benefit (CPDB) will pick up where the temporary program leaves off, but without a complete guarantee of what it will provide, seniors cannot be sure that they will have the adequate drug coverage they need later on.  Therefore, Bush’s proposal for drug coverage falls short of Edwards’ and Kerry’s plan overview to protect seniors from a high out-of-pocket cost for prescriptions.  In the area of coverage, Kerry’s Four-Step Plan to Restore Medicare has by far the most well thought-out drug coverage.

Despite the importance of accessible and adequate prescription drug coverage, it is more important to prevent serious illnesses from occurring through regular physical exams at the doctor’s office.  Bush proposes in his “Framework to Modernize and Improve Medicare Fact Sheet” (FMIM) which gives seniors the option for a more enhanced form of Medicare (Bush, par 5).  This proposal includes full coverage for preventative care, which the current Medicare does not include.  Most importantly, it is more cost efficient if seniors are given regular physical examinations that will pinpoint problems at the start. To provide preventative healthcare could mean the difference between having to suffer a high-cost and painful surgery and taking a round of medication to treat it when surgery is not needed.  In this aspect, Bush’s proposal appears promising because it seeks to provide preventative care in an effort to avoid or treat illnesses at its roots.  Edwards does not directly address preventative care per se, but he proposes a greater outreach to seniors in rural communities through telemedicine which is a combination of high-tech computer technology and medical care (Edwards, par. 5), all of which make preventative care possible in the end.  It is evident that Edwards’ ARS had preventative care in mind by addressing the equipment needed to carry out this proposal. Therefore, access to advanced technology will undoubtedly make preventative care feasible and more effective, making Edwards’ ARS a reinforced and more complete plan.  Also, because ARS proposes to include seniors in rural areas, it is the best candidate to fulfill the initial intention to help seniors.  Kerry in his “Four-Step Plan to Restore Medicare” does not address the need for preventative care in the current Medicare coverage which is so crucial to seniors.  His main focus for restoration of Medicare is prescription coverage and does not address the preventative are at all.  As a result, Edwards’ ARS is the most promising and feasible because it takes a step further than Bush’s proposal to make preventative care available to seniors, which Kerry fails to address because it offers the technology to make this a more comprehensive possibility rather than a plan  that is partially addressed.  John Edwards’ proposal not only indirectly supports preventative care, but he also seeks to ensure that no senior is left behind or forgotten (Edwards, par. 5).

Edwards’ ARS takes an integral first step to include all seniors across the nation with the current Medicare which may be deemed insufficient.  Although Bush and Kerry’s proposals have good intentions to reach out to seniors, it cannot only be focused on those who already have coverage.  Who is going to look out for those who need it and are not informed enough to know that they are eligible?  Edwards’ proposal, although not improving today’s Medicare in terms of adding more coverage, is an integral stepping stone in educating the elderly of healthcare opportunities.  After Edwards’ ARS is implemented, we can then begin to integrate Bush and Kerry’s proposals to refine the Medicare health plan system. 

Works Cited

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<www.research.aarp.org/health/2004_06_drugprices.pdf>

Bush, George W. “Framework to Modernize and Improve Medicare Fact Sheet.”

4. February 2004. The White House. 26. May 2004.

<www.whitehouse.gov/news/releases/2003/03/20030304-1.html>

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Ehrenreich, Barbara. Nickel and Dimed. New York, New York. Henry Holt and

Company. 2001.

Graverly, Virginia. Personal Interview. 2. June 2004.

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