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WHEN DONUTS ATTACK. Up till now, seniors have been mostly satisfied with the Medicare Drug Benefit. Bad bill though it is, it remains better than no bill at all, and since that was the comparison, approval ratings have remained high. Call it the soft bigotry of low expectations. Unfortunately for the Bush administration and the Republican Congress, that may be about to change. Millions of seniors are about to tumble into the donut hole, a coverage gap that extends (usually) from $2,250 to $3,600, at which point federal insurance kicks back in. Most seniors, as we already knew, were unaware of the gap. And this is what it looks like when they fall in it:
Frances Acanfora, 65, had been paying $58 for a three-month supply of her five medications. But this month the retired school lunchroom aide learned that her next bill would be $1,294. She had entered the doughnut hole.[...]After talking to her doctor, Acanfora decided to temporarily stop taking a drug as part of her treatment for breast cancer. She hopes to obtain some free samples of eye drops for her glaucoma. Three other medicines -- for high cholesterol, diabetes and osteoporosis -- cost $506.62, which Acanfora put on her credit card."I pay a little bit at a time," she said. "What am I going to do? I need it. . . . Sometimes, just to think about it, I cry."In case anyone's wondering about the staggeringly strange structure of it all -- don't. It makes no sense. The concept behind donut holes is that they ensure coverage for basic care, so folks don't skimp on preventive and diagnostic services, then impose a certain level of cost-sharing in order to incentivize all those magical things price-conscious consumers apparently do, then pick up the coverage again for those who are simply ill. It makes a certain amount of sense -- unless you're dealing with prescription medications for seniors. Prescriptions aren't unexpected costs. They don't rise and fall on the consumer side -- they're prescribed by doctors and purchased at a monthly fixed sum. If the federal government thinks seniors don't need the prescriptions they're taking, it should direct doctors to stop prescribing with such abandon. But you're not going to change prescription behavior with cost-sharing, except to make people take less of them. Which could kill them, or land them in the ER with hypertension and a stroke. But rendering a senior unable to purchase her breast cancer medication isn't going to somehow alleviate or cheapen the burden of the illness; it's just going to endanger her life and possibly force the system to spend far more on chemotherapy and intensive treatment. It will also make her, as well as her friends and family, angry. She multiplied a million times, in retirement communities and assisted living centers all across the country, six weeks before an election, with nowhere to place her fury save a ballot.
