At a State House forum on prescription drug coverage for elders last week, I talked to several senior advocates. Ed Schwartz of Arlington, a volunteer for Minuteman Home Care Agency, told me about one of his clients whom he has counseled.
The client is 77, a veteran of World War II who has some serious health problems. His income puts him just above the poverty level so he does not qualify for Medicaid. However he can’t afford the drugs that have been prescribed for him.
How does he handle the problem? Like most elders in this situation, he cuts back not on food or rent, but rather on the drugs. “Long run, this is detrimental to his medical problems,” says Ed Schwartz.
But Ed takes heart from the recent increase in the state’s senior pharmacy program. Elders who are eligible will find their drug allowance increasing from last year’s $750 to $1250, a rise that Schwartz calls a “real boon” for his client. Details about eligibility are available at 1 (800) 813-7787.
As this program suggests, Massachusetts is making a strong effort to provide for its elder citizens coverage that, almost everyone agrees, should be provided by the federal government. As Senator Edward Kennedy said in a speech videotaped for this forum, “Medicare is a broken promise” because it leaves so many elders vulnerable to exorbitant drug costs.
The Gerontology Institute at UMASS Boston and the Legislative Caucus on Older Citizens’ Concerns co-sponsored the forum. Its purpose, in the words of chief organizer Ellen Bruce, was “to bring together both policy makers and constituents and some drug industry people as well.”
Everyone has mixed feelings about the Massachusetts program. On the one hand, the Commonwealth has responded imaginatively and generously to serious need. As health care expert John McDonough of Brandeis University told me, “I think we in Massachusetts are making good progress.”
But, on the other hand, there is a widely shared awareness of the limitations of efforts made by any single state, however generous. Ellen Bruce puts the case well: “You can’t wait on the federal government. It probably is a collaborative effort that is needed.”
Professor McDonough, who in his time as a member of the Massachusetts House of Representatives took the lead on health care legislation, outlined masterfully the issues affecting the price and availability of prescription drugs. The continued rise in costs is highly undesirable now and can only get worse. However, he refuses to blame any one sector or group of people. “There are no heroes or villains,” he maintains.
Judith Kurland, New England Regional Director of Health and Human Services in the federal government, showed herself less reluctant to assign responsibility. “The drug companies are making more money than any other industry,” she charged. And, she claimed, some of them are using their economic power to buy up generic drug companies so as to make that cheaper option less available.
To apply brakes to runaway costs, she laid out several options. In her opinion, focusing on increased coverage would simply put more pressure on the whole health care system. Instead, she favors placing limits on the costs of drugs. This step, however, would run the risk of the drug producers claiming that cost controls will kill the industry.
Her favored option seems to be the pooling of resources. If purchasers in New England got together, she figures, they would have purchasing power equivalent to all of Spain.
Finally, Representative Harriet Chandler of the Joint Health Care Committee, emphasized the complexity of the problem and urged elders everywhere to keep lobbying the federal government for needed action.
Emphasizing the crisis that presses on elders who need drugs to maintain health, she said, “We are in a form of triage now.” Changing the metaphor she added, “We have put our finger in the dike but we need the leadership of the federal government.”
Meantime she feels proud of a new Massachusetts program that goes beyond the expanded drug coverage noted above. This new provision is aimed at so-called catastrophic costs, amounts so large almost no one can pay them.
Scheduled to start on January 1st (though some think a date in the spring is more realistic), this emergency program has no upper limit for costs. It will include elders with incomes up to a little more than $40,000.
The next immediate challenge is to get word out about what Massachusetts is doing to help elders crushed by prescription drug costs. Over the last several years, the Senior Pharmacy Program has not enrolled nearly as many elders as expected. Of the thirty million dollars that has been allocated each year for this purpose, sixteen million is the most that has been spent. In any single year, only twenty-six thousand elders have taken advantage of the plan.
The task for elder advocates is two-fold. Spread the word about the state program to everyone you know. And let members of congress know you want Medicare expanded to cover prescription drugs.
Richard Griffin