On July 30, 1964, President Johnson traveled to the Harry Truman Library in Independence, Mo., to sign Medicare into law. With the stroke of a pen, he overcame decades of resistance from organized medicine and helped 20 million Americans over age 65 rest easier, knowing that they would have a guaranteed way to pay for medical care.
Thirty-five years later, Medicare is once again at the center of a vigorous policy debate as the Clinton administration grapples with a new issue: Should the government help pay for prescription drug coverage outside the hospital?
Drugs played a much smaller role in medical care 35 years ago. The powerful and sophisticated breakthrough drugs commonly used today to treat heart disease, ulcers, depression and other diseases were still largely undiscovered. Doctors were much more likely back then to perform surgery and prescribe hospital bed rest for patients afflicted with a range of illnesses.
Not so today. The pharmaceutical revolution, which saw 90 new drugs approved in 1998 alone, has been a tremendous boon to the health of seniors. While 80% of seniors take at least one prescription medicine a day, it is not unusual for them to take multiple drugs. Many of these new drugs are quite costly, and this poses a serious problem for seniors who cannot afford them.
About 35% of the elderly nationwide have no outpatient prescription drug coverage whatsoever. Among those who do, some are covered by their former employers' retirement plans; others are covered by privately purchased Medicare supplemental "Medigap" policies; the poorest are covered by Medicaid; and some are covered by a Medicare managed care plan. In California, more than 98% of people enrolled in a Medicare HMO have some drug coverage.
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While it is encouraging that a majority of seniors' prescription drugs are paid for, it may not stay that way. According to some health policy experts, supplemental policies, like Medigap, which offer some protection against the high cost of drugs, may become harder to purchase and less generous with benefits over time.
Gaps in coverage leave many seniors wondering how they will pay for expensive drugs while still covering other living expenses. As a consequence, they often cut pills in half, skip doses or leave prescriptions unfilled, creating potentially life-threatening situations. The desperation of many patients for life-saving drugs is also evident in an underground trade in unused or even outdated drugs.
