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When Prescription Pain Persists...

A BUZZFLASH GUEST CONTRIBUTION
by Michael Winship

Timing -- the secret of my success. I spent a few days in sunny, warm Key West last week and adroitly managed to coordinate returning to Manhattan with the worst blizzard ever recorded in New York City history.

Oddly, while strolling around that Florida island, its main boulevard, Duval Street, overflowing with tourist trap saloons and single entendre tee-shirt shops, two distinguished senior citizens of the 20th century came to mind: Harry Truman and my dad.

Truman because, during his White House years and after, he spent vacations in Key West, staying at the home of the naval base commandant. He loved it there: he could put on a tropical shirt and golf, fish, drink a little bourbon and play poker with his pals. He wrote his wife, Bess, "I've a notion to move the capitol to Key West and just stay."

I thought of my dad because, in the old Strand movie theater on Duval, there's now a big Walgreen's drugstore. My father owned a Walgreen's on the main street of my hometown in the Finger Lakes region of upstate New York.

He was one of the last of the old breed of pharmacists, trained to concoct his own prescription remedies. And as a merchant, he ingrained in his employees the famous two Rules of Retail: 1) The customer is always right, and 2) See Rule 1.

What also links Truman and my father, other than buildings in Key West, is -- wait for it -- Medicare.

In 1965, Harry Truman sat next to President Lyndon Johnson at the Truman Library in Independence, Missouri, as Johnson signed into law the bill that created Medicare for the nation's senior citizens. At the ceremony, Truman was issued the first Medicare card.

"I am so proud that this has come to pass in the Johnson administration," LBJ said. "But it was really Harry Truman of Missouri who planted the seeds of compassion and duty which have today flowered into care for the sick, and serenity for the fearful."

Now we're engaged in great changes in Medicare, beginning with the new prescription drug benefit, aka Medicare Part D, and I wonder how my father, the pharmacist and retailer, would have reacted.

I suspect the complicated rules; the confusion, the bureaucratic loopholes, snafus and inadequacies of the prescription bill would have annoyed him. And the ways in which insurance and pharmaceutical companies, their lobbyists and paid-for legislators have flimflammed the public would have offended him as a flagrant violation of that first rule: the customer -- in this case, America's 42 million elderly and disabled -- is always right.

The underlying dilemma, as outlined in a February 6 New York Times analysis, has been trying "to blend a classic big government program from the Great Society with the conservative, market-oriented philosophy of the Republicans in power."

Administration officials continue to believe the benefit will work and bring those affected more coverage at much lower prices, but, as the Times reported, "In recent weeks, older Americans have struggled to choose from a dizzying array of 40 or more drug plans, with different premiums, co-payments and lists of covered drugs. States have intervened to cover many low-income elderly beneficiaries who were falling between the cracks in their transition to the new Medicare program. Pharmacists have reported delays and difficulties in determining who is eligible for which benefits."

Liberals, as the Times pointed out, thought the best way to create a Medicare drug benefit was just to add one to the existing program: "Let the federal government use its immense bargaining clout to secure discounts and provide a standard benefit, just as it does for hospitals and doctors."

But Republicans wanted something more market-driven -- if by market you mean a labyrinthine Turkish bazaar of private insurance plans that adds hundreds of billions of dollars to the national debt and that may or may not suit your pharmacological needs. If, for example, a certain drug proves a drag on an insurer's profit, they unilaterally can remove it from their plan at a moment's notice.

What's more, as California Congressman Pete Stark wrote last week in an op-ed for the Knight Ridder newspapers, "The law actually prohibits Medicare from negotiating lower prices for prescription drugs... prices in the program are considerably higher than what the government pays through the Department of Veterans Affairs or Medicaid, and generally comparable to what the uninsured can get at drugstore.com or Costco. That's a raw deal for beneficiaries and taxpayers, but a great deal for shareholders and corporate executives."

For the problem isn't just about philosophical differences between liberals and conservatives. Keep in mind the ignominious way in which the legislation was birthed back in 2003, an intrinsically flawed hodgepodge of various schemes hammered together by lawmakers working with 750 industry lobbyists. To make the benefit a reality, the pharmaceutical companies spent more than $100 million (not including campaign contributions).

With barely any time for deliberation, the 678-page bill was voted on in the wee hours of the morning, a vote held open two and a half hours beyond the normal 15 minutes while Republican leadership, including Speaker Denny Hastert and Majority Leader Tom DeLay, cajoled, threatened and harangued members until it was passed, 220-215.

Its true cost -- $534 billion, as opposed to $400 billion -- was hidden from Congress. When a government actuary tried to blow the whistle, Medicare head Thomas Scully threatened to fire him. A week after the legislation was signed, Scully took a job with a legal firm representing major health care clients affected by the law.

Not long after that, one of the bill's chief engineers, Louisiana Congressman Billy Tauzin, became head Washington lobbyist for the Pharmaceutical Research and Manufacturers Association.

So what do we do? As Medicare expert and Urban Institute president Robert Reischauer told the New York Times, "We have in this country a long tradition of passing seriously flawed legislation, and then spending the next decade trying to fix it, to the extent possible." Over the President's Day recess, Democratic members of Congress are being urged by leadership to hold town meetings to urge an overhaul of the program, receive feedback and establish the benefit's flaws as a midterm campaign issue for the fall.

Beyond that, we have to face facts, reason together and once more attempt what all sides have been avoiding for the last decade: comprehensive healthcare reform.

I know. Laughter is the best medicine.

A BUZZFLASH GUEST CONTRIBUTION

Michael Winship, Writers Guild of America Award winner and former writer with Bill Moyers, writes this weekly column for the Messenger Post Newspapers in upstate New York. Copyright 2006 Messenger Post Newspapers