When you were younger, did you ever imagine needing a Ph.D. to understand how to pay for your prescription drugs in later life? That is about where we have arrived with the passage of the so-called “Medicare Prescription Drug, Improvement and Modernization Act of 2003.”

A recent headline “Medicare Law Befuddles Elders” aptly describes the mental condition of most among us who have paid any attention to the recent restructuring of Medicare. Except for blasting AARP for selling out our interests, I have suffered enough befuddlement myself to discourage me from writing much about the subject till now.

The very name of the new legislation rankles me. Improvement? Modernization? Both words are politically charged and hide the antisocial philosophy that lies behind the changes in Medicare. They also disguise the fact that the 700-page legislation favors drug companies at the expense of consumers.

I still hope for changes in the new law, if not ideally its complete repeal. And yet, facing reality, I believe that older Americans should take advantage of whatever help we can get now to pay for our medications. The cost of many drugs lies increasingly out of reach for so many of us that we cannot afford to pass up help.

Though the full legislation does not kick in till 2006, this is the month when Medicare Drug Discount Cards have become available, their appearance signaling the first opportunity, due in June, for some elders to save money on medication purchases.

Getting word about the new cards to older people is crucial, says CMS (Centers for Medicare and Medicaid Services), the federal agency responsible for implementing the changes. Otherwise, its administrators fear, almost three million eligible beneficiaries will fail to register and thus forfeit access to a $600 annual subsidy, plus other possible savings.

This is why more than 100 national organizations have banded together to spread the word. They include AARP, the National Council on the Aging, and Catholic Charities USA. This coalition believes that “Few low-income beneficiaries are likely to know that they should not only consider enrolling in a Medicare discount card but also continue to take advantage of existing public and private prescription savings programs.”

In a slide show, the coalition shows how the difference for some could amount to far more than the basic credit of $600 that comes with the card for many low-income people. They show a 68-year-old Louisiana woman saving $1,320 and an Idaho man $5,058, largely through taking advantage of discount programs given by the drug manufacturers.

Compared to the rules set for 2006, those for the cards seem relatively simple. However, even here most older people will need some explanation of the system before making wise choices. And, after grasping how it works, we will require further help to discern which card will serve us best.

Those considering the cards will have to ask questions: How convenient are the pharmacies where the particular card can be used? does the card cover the drugs they need? does it offer the best price for these drugs?

Fortunately, those who already belong to Massachusetts’ Prescription Advantage program do not need to sign up for the discount cards.

I recommend taking counsel from the SHINE Program, run by the state Department of Elder Affairs. SHINE operates in the Councils on Aging in Massachusetts cities and towns, with cooperation from the state home care agencies in each part of the Commonwealth. Through this program, professionals and volunteers trained in financial and other issues provide information and counseling to older people who request it, free of charge. You can reach this source of help by calling 1 800 AGE-INFO.

If you use the Internet, you can find details about the drug discount card by tapping into the Medicare web site www.Medicare.gov. Otherwise you can call a toll-free number: 1 800 MEDICARE.

AARP also has helpful information at www.aarp.org, and, by telephone, at 1 888-OUR-AARP. The latter organization also offers callers a well designed booklet (with a title in small caps): “medicare changes that could affect you.”

Again, if you have Internet access,  I strongly recommend reading what the Families USA Foundation offers at www.familiesusa.org.  It describes the discount drug card program as “very flawed” and gives reasons why it does not serve the best interests of consumers. But it also offers guidelines for choosing the discount cards.

I hope that the new program will serve elders well but fear otherwise. How can we expect much good to come from a law that prohibits the federal government from bargaining with the drug companies for lower prices?  And how can users of the discount cards be confident of savings when the companies and other agencies that sponsor these cards are allowed to make indefinitely large profits by raising prices with only one week’s notice?

All of this is further argument for getting help in finding your way through this maze of laws and rules. Again I recommend asking the SHINE counselors for assistance as the best resource.

Richard Griffin

As I lay upon my bed, my mother gently took my left arm and raised it above my head. Then she moved it down toward my side, all the while speaking to me words of encouragement. She explained how this exercise would make stronger an arm that had recently become much easier to move. At age 33 she was doing her best to help me, her first-born, get the most use of a limb damaged at birth four years previously.

Looking back some 70 years to this experience, I recognize it as my earliest memory. Even now I can feel the reassurance in my mother’s voice as she carried out doctors’ instructions to improve the use of my arm after surgery to repair my damaged muscles.

My mother, Alice Barry, grew up in Peabody, Massachusetts in a household that was formed in the Victorian period and had imbibed many values of that culture. Outwardly, she seemed to break with that regimen in her early adulthood. In the 1920s after her graduation from college, she was one of the first young women in her milieu to own a car and she sported what looked like a carefree lifestyle.

She herself used to tell me that this was the best time to have lived, the Roaring Twenties, when freedom reigned and our country was at peace. In response I would take issue with her and suggest that her being young and in good health was the reason why the times seemed so good to her; I also gently suggested that the good times were limited to people of her social class.

The older she got, the better that era looked to her because of the many problems that assailed her. The worst was the anxiety that plagued her inner life: from age 40 on, she suffered from scruples and other mental problems. I remember the crucial point at which, out of fear, she gave up driving the family car.

In mid-life, Alice also suffered life-threatening cancer. Surgery brought her through this crisis but she had to endure its effects for the rest of her life.

My mother also had external events that were difficult to cope with. The worst of these, by far, was the death of her husband, my father, when he and she were only in their middle 50s. After that catastrophe she was never the same.

Her husband’s death left her with responsibilities that she was not prepared to handle by herself. Only two of her six children were on their own at this point. Like many middle-class women of her time and place, she was not skilled in business matters and was hard pressed to deal with other major decisions suddenly thrust upon her.

 Writing about my mother from the vantage point of my current age, I am giving a different account from what I did earlier in my life. I like to think I now bring to my mother’s life a greater empathy than was possible when I was young. Age allows me to enter into the misfortunes that she suffered and the inner demons that afflicted her.

The injury that I suffered at birth must have been especially difficult for her. For her to have begun child-bearing this way probably stirred feelings of guilt and regret.

So my mother’s life was hard in many ways. However, she did have the satisfactions of seeing her children grow up healthy and reasonably successful, and she enjoyed the pleasures of her grandchildren. When she suffered physical decline, she received loving concern and help, especially from her two daughters, making her last years somewhat less anxious than the earlier years.

My mother passed on to my siblings and me a strong physical inheritance that has already assured us relatively long lives. And she gave us a set of values that have proven vital in an era marked by sudden and drastic change. Even in the midst of her many difficulties, she persevered in love for each of us and she supported us in our basic choices.

Still, I wish that she could have known more inner peace. A prime source for that might have been her religion but, unfortunately, she seems to have regarded that as more a source of obligations than of consolations. The faith which she professed throughout her life would appear to have brought her little serenity. I will always regret that she could not have known peace on mind and heart.

As Mother’s Day 2004 approaches, I thank God for my mother and appreciate the many gifts she gave me, life itself being the most precious of them. On this occasion, I like to think back and see her as I never did with my own eyes: a young, carefree woman driving her car, scarf flying in the wind, laughing with friends in the spirit of the Roaring Twenties.

Richard Griffin

Travel can sometimes have spiritual impacts that surprise us. I refer, not to religious pilgrimages where that is the whole point, but rather to the stirring up of old friendships. Visits to San Francisco and New York recently did that for me and I am the better for these encounters.

In the first meeting I spent time with an old friend (whom I will call Charley) from whom I had felt somewhat estranged. This happened, not because of any quarrel between us, but rather because of problems my friend was experiencing in his family life.

His differences with his wife affected me because my wife and I were friendly with her. Though we did not actively take sides, the rift between them spilled over. Whenever I ran into Charley in the last few years I would feel that the affection between us had been spoiled.

On this occasion, however, he freely entered into conversation with me and we had a heart to heart talk in which he shared his inner experience with me. I quickly discovered that he felt no hostility toward me: I now felt restored to the intimacy that we had enjoyed before.

Charley now lives by himself and has become spiritually reconciled to that fate. He has lost his family, at least for the foreseeable future. He finds it difficult to live alone but has found much consolation in the practice of the spiritual life. He has discovered centering prayer, an approach to contemplation that brings him comfort.

As our conversation went on, it became clear to me how Charley has undergone an inner renewal that helps him deal with the difficult history of his family life. He knows his own responsibility in that breakdown but has learned how to accept what is now. In doing so, he has had the help of a spiritual counselor who has provided sensitive and effective guidance.

I came away from this encounter with Charley feeling renewed and uplifted. Being restored to intimacy with him has heightened my appreciation of personal relationships. I now hope to stay in active touch with Charley and continue the dialogue so agreeably restarted in San Francisco.

Last weekend brought me to New York where I renewed personal contact with an old friend whom I had not seen for some 30 years. It was a pleasure to share brunch and converse with him, his wife, and his two daughters as we reviewed some of our past adventures and exchanged news about current activities.

Retired now, this friend (whom I will call Bill) lives in Manhattan and enjoys life in the big city. He has the good sense to continue working for others, in particular making his free time available to fellow educators. Bill has been blessed with enough income to fund a life style that is gracious and expansive. His wife has continued running her successful interior decoration business.

Bill is one of the many people who have redefined retirement as an opportunity to shift gears and take on new projects. He gets paid for some of his activities, such as teaching in a professional school, while he does others gratis for the benefit of those in need. Doing things for the common good makes a lot of sense to him now that he has time to spare.

That free time also enables him to contribute to the home life of his wife and himself. When she returns from her commute at the end of the day, he frequently has dinner ready for her, along with freshly bought flowers. The quality of their affection for one another is manifest, and not only in details like these.

The parents take obvious pride in their daughters, young women around 30, and relish the younger woman’s activities as an actor and playwright. The older daughter works in her mother’s business, much to the satisfaction of both of them, it would appear.

Bill did not share much with me explicitly about his spiritual life, although it seems to me clear that he has high ideals inspired by the religious tradition in which he grew up.     

The gracious hospitality that Bill and his family showed to me and my family on this occasion stirred not just our thanks but also the admiration and affection that remain at the root of our long-lasting friendship. It would be unrealistic to claim that the passage of those 30 years had changed nothing. However, the feelings that we first had for one another long ago had clearly lasted.

Two encounters, one on the west coast, the other on the east, one planned, the other accidental, brought me together with old and valued friends. I take these two meetings as a source of spiritual grace and blessing. Finding that these friends still care about me and I about them has provided me with renewed feelings of worth on both sides.

Richard Griffin

Two Sundays ago, the face of a friend known to me since her college days, some 35 years ago, appeared among the wedding announcements of the New York Times. Helen Cooksey was announcing her marriage to Susan Love, after their taking advantage of the short official-wedding gap opened by the Mayor of San Francisco in February. Both physicians who are based in Los Angeles and parents of a daughter now grown up, these two women obviously felt intense happiness at having their bond legally recognized.

Their joy reminded me of that felt by hundreds of other lesbian and gay couples in that place and in several other American cities. I was particularly struck by those first in line in San Francisco – Del Martin, 83, and Phyllis Lyon, 79 – who have been partners for 51 years. Such longevity in love ought to impress everyone.

A look at recent polls reveals, however, that 60 percent of Americans over age 65 oppose the legalization of gay marriage. This contrasts with a scant 23 percent of those under age 30 who stand against.  

Does this mean that a great many elders are taking a kill-joy attitude toward fellow members of our national community who have discovered a personal love that has stood many tests of time and has continued to bring them fulfillment?  Are older people hard of hearts as well as (sometimes) arteries? Is it that they are simply old, stuck in their ways, and unable to change? Or do they have something significant to bring to the debate?

In searching for answers to these questions, I have not simply talked to some of my age peers but have tried to untangle what may be part of their underlying mentality. The issues that polls never get deep enough to analyze are those that may play an important part here.

Many, if not most, of those over 65 must surely find some pleasure in what others see as good fortune for themselves. Is it not likely that others feel the way I do, namely joy at others having the benefits of being bound to others in love and fidelity?

Elders in good physical and mental health are certainly open to change. Their ability to transform behavior and attitudes has been documented sufficiently to chase this stereotype.

That a large percentage of those who oppose gay marriage do, at the same time, support civil rights and widespread benefits for those entering sexual unions attests to their openness. Endorsing civil unions represents a major transformation of mentality for many people who never heard of such arrangements until quite recently.

Still, many advocates of civil unions refuse to accept legal marriage of same- gendered people. I would point to three separate considerations that might be moving those over 65 to opt against gay marriage. If advocates wish to change elders’ views, I would suggest taking these issues seriously.

First, to people growing up in homes shaped or influenced by classical culture, the naming of things makes a difference. Older adults, even if not highly schooled, have lived their whole lives in a mental framework that values things by their names. Literature, philosophy, and theology that have had such an impact on our lives, at least indirectly, have taught us to distinguish among things that are different.

In this view of reality, the word marriage does not apply to gay unions. Marriage means the coming together in a permanent sexual bond between people of different genders. For these “classical” thinkers, another kind of union –  –  however desirable in itself –  –  requires another name.

Secondly, there are large numbers of Catholics in Massachusetts, and the teaching of their church makes gay marriage problematic. You can believe (as I do) that the Catholic Church stands in bad need of a new approach to sexuality, but it does not have one yet. Furthermore, Catholics have the sense of belonging to a worldwide church, one that is unlikely to adopt a position that runs counter to the culture of other nations.

Finally, not a few older people may feel that society is moving too fast on this issue. After all, even the well-informed may not have heard of the legalization of gay marriage as a possibility until very recent months. People need time to think about it. Those who have reached seventy or eighty know from experience that history is full of unintended consequences. A decision of this magnitude should not be taken in haste; it deserves ongoing analysis and reflection.

These oppositional views are not those of all elderly people. As we have seen, some of the couples married in San Francisco are far from young. But the views of more skeptical or conservative elders should not be seen simply as an expression of blind prejudice. If we are to proceed in amity as a society, they should be accorded the same presumption of good faith that is owed to the proponents of gay marriage.

Richard Griffin