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Commentary | LETTERS TO THE TIMES

Repair Medicare Drug Plan

March 06, 2004

Re "Fix the Sloppy Medicare Reform," by Irene M. Wielawski, Commentary, March 2: Finally, an article that logically and without prejudice discusses some of the sacred cows in opinions on an entitlement (Medicare). We are wasting huge amounts of our federal budget on medical spending on the well-to-do elderly. Do we want to pay Medicare and Social Security dollars to Bill Gates' father, or do we want to provide medical care for the children of the working poor and near poor?

Also, do we want to pay for drugs and treatments that either have not been proven effective or have cheaper alternatives that work as well? We have to allow responsible medical plans the ability to regulate in these areas without forcing them to spend a good deal of our healthcare dollars to protect themselves from rapacious lawyers and legislators who have never seen an entitlement they didn't love.

You are bringing back some logic and civility in the discussions of these issues by publishing such a thoughtful, rational and easy-to-understand article. Our public servants have to consider the spending of our tax dollars as if they were their own and that they have a budget to keep to. Careful, rational choices must be made.

Susan E. Glasser MD

Los Angeles

Wielawski is right to call upon Congress to safeguard our healthcare dollars under the new Medicare prescription drug law. However, our information needs regarding new drugs go well beyond what existing science has to offer about cost, quality and appropriate use. To make the best decisions about what to prescribe for their patients, physicians require sound scientific evidence about available therapeutic options and their relative cost-effectiveness.

The Medicare program currently does not consider cost-effectiveness when making technology coverage decisions, nor is it likely to do so in making decisions about prescription drug coverage. Without information on the comparative cost-effectiveness of competing brand-name and generic drugs, affordable healthcare for our seniors will remain a dream. In fine-tuning the new law, Congress not only should insist that Medicare gather and use information of this kind but also that Center for Medicare and Medicaid Services administrators invest adequately in research that will produce such information.

Alan B. Cohen

Executive Director

Boston University

Health Policy Institute

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