Monday, September 18, 2000

Seniors distrust candidates on Medicare

Drug coverage not the only problem area

By Tim Bonfield
The Cincinnati Enquirer

        Ask Tristate seniors about Medicare, and you'll get an earful of concerns about the rising price of prescription drugs, worries about the future of Medicare HMOs and complaints about all the paperwork.

        Ask seniors about what the next president should do about Medicare and you'll get a lot of disagreement over policy and a strong dose of skepticism about campaign promises.

Tell us what you think about the candidates' proposals
What candidates propose on Medicare
        “I listen to all the talk, but I don't think they're going to do anything,” said Anderson Township resident Barbara Frueauff, 71. “I'm not happy with any of them.”

        Roselawn resident Thomas Lounds, 89, said he feels swamped by campaign slogans: “There are so many ads. (The candidates' proposals) aren't clear to me.”

        While education and character issues have dominated most stump speeches, candidates Al Gore and George Bush have vowed to protect and expand the 35-year-old federal health plan for the elderly and disabled. Both have recognized that the future of Medicare ranks among the most far-reaching issues of the 2000 election for a variety of reasons:

        • The program is precious to a huge group of voters. Medicare spends more than $217 billion a year on care for more than 39 million elderly and disabled Americans. Those figures include 135,000 enrollees in Hamilton County and 122,000 more in 12 surrounding Tristate counties.

        • Medicare's importance will only mushroom as the baby boom generation ages. By 2020, Medi care will cover 61.7 million people at a cost exceeding $1.1 trillion, according to projections from the Health Care Financing Administration.

        • Beyond affecting seniors' health, the Medicare program influences the entire medical industry, from the bottom lines of giant pharmaceutical companies to the paychecks of remote country doctors. That means powerful health-care interest groups will play a large role in shaping Medicare's future.

        With so much at stake, Mr. Bush and Mr. Gore routinely use sweeping terms to describe their Medicare proposals.

        While accepting his nomination Aug. 17 at the Democratic National Convention, Mr. Gore described strengthening Medicare as a basic “family value.”

        “I will fight for a prescription drug benefit for all seniors under Medicare. It's just wrong for seniors to have to choose between food and medicine while the big drug companies run up record profits,” Mr. Gore said.

        When releasing the first details of his Medicare plan during a Sept. 5 speech in Allentown, Pa., Mr. Bush broke ranks with the history of the Republican Party, which opposed the creation of Medicare in 1965.

        “My party has often pointed out the limits and flaws of the Great Society. But there were successes as well — and Medicare was one of them,” Mr. Bush said. “By history and choice, our nation makes a promise: We will honor our fathers and mothers by providing quality health insurance to every senior citizen. Keeping the promise of Medicare and expanding it to include prescription drug coverage will be a priority of my administration.”

        Promises. Promises.

        “They both talk good. But isn't that the usual for a campaign?” said Clifton resident Dorothy Abt, 81. “But if we keep after them, maybe they'll do something. We put them in there. Now we need to tell them what we expect them to do.”

        Many seniors, rich or poor, sick or well, agree that the rising costs of prescription drugs has become a struggle.

        “Some people don't need it,” Mrs. Abt said. “I know one woman who's 90 years old and only takes one pill. But I know more people who have $200 to $300 a month in prescriptions.”

        In Greater Cincinnati, the prescription drug issue is closely tied to recent concerns about Medicare HMOs.

        Since 1995, more than 65,000 seniors have flocked to Medicare HMOs, often because the plans were among the few to offer affordable drug coverage. However, 27,000 of those seniors found out this summer their HMOs would be dropping them next year because the plans aren't making enough money.

        Medicare HMOs were the centerpiece of the last big Medicare reform, a program dubbed Medicare+Choice. The bitter experience in Cincinnati and many other cities has made some seniors skeptical about new Medicare ideas.

        “A lot of seniors are sincerely upset about (the HMO pullouts),” said Jean Timberlake, 68, of Roselawn. “A lot of people are wondering, "What am I going to do next?'”

        Mrs. Timberlake said she spends more than $250 a month for prescriptions to treat her asthma, arthritis and a bladder problem. A month's supply of one pill costs $112.

        Those medications may extend and improve her quality of life. They may even prevent expensive emergency room visits and hospital stays. But while it covers other basic aspects of health care, Medicare doesn't cover prescription drugs.

        To get help with drug bills, seniors have these options:

        • Be poor enough to get help from state Medicaid programs.

        • Join an HMO.

        • Pay $2,000 to $4,000 a year for a private supplemental plan that covers prescription drugs.

        Assuming the next president can muster enough cooperation from Congress — no small feat — both candidates propose making drug coverage simpler for many seniors.

        Both propose providing full drug coverage at no cost to a larger group of low-income seniors.

        For example, Mrs. Abt would get full drug coverage at no cost under either candidate's proposal because she lives on a Social Security check of $638 a month — well below thresholds proposed by Mr. Gore and Mr. Bush.

        Right now, Mrs. Abt pays $60 a month in co-payments for four medications under a Medicare HMO — one that plans to pull out of Cincinnati this year. The full retail price for her pills would be $137 a month.

        For seniors with higher incomes, the impact of the proposals would vary.

        Mr. Gore's plan calls for Medicare charging a $25 monthly premium that would then cover 50 percent of a senior's prescription bill.

        It is unclear whether participation would be mandatory for seniors who already have private coverage. If so, some well-off seniors could get less coverage than they pay for now.

        Mr. Bush would offer seniors the option of buying coverage from private insurers. Plans would cover 50 percent of drug costs after a $250 deductible. Monthly premiums have not been specified.

        Mr. Bush says he supports partially subsidized premiums for moderate-income seniors who wouldn't qualify for full coverage. Whether his plan offers better coverage than existing private plans depends on the amount of medication a senior needs and the coverage limits of the plans.

        Mr. Gore's plan ($253 billion) would cost more than Mr. Bush's plan ($159 billion). But Mr. Gore's plan offers more benefits.

        Not all seniors think Medicare is broken badly enough to require major fixing.

        Audrey Diehl, a 74-year-old resident of Evendale, said only the most needy should get drug coverage.

        “If you can take care of your self, do it. Don't ask the government for help,” she said.

        The prescription drug issue ranks as the top concern among members of AARP, the nation's largest senior group. But seniors do not appear ready to vote for a president based exclusively on the prescription drug issue.

        “Gore has a decided advantage on this issue, but some seniors will find Bush more attractive for other reasons” said John Rother, AARP director of legislative and public policy. “Seniors have a wide range of concerns, from education to Social Security to moral values.”

        Meanwhile, big interest groups have their own concerns about Medicare reform.

        Hospitals, which depend on Medicare for 40 to 60 percent of their total budgets, are worried about the costs of a drug benefit — especially Mr. Gore's plan.

        “We are very concerned about where the money would come from. We haven't heard an answer to that from either candidate,” said Lynn Olman, president of the Greater Cincinnati Health Council. “Drug coverage is very desirable, but it's very expensive. We just don't want the problem solved on the backs of the providers.”

        Drug companies prefer Mr. Bush's plan to Mr. Gore's. They fear a drug benefit with Medicare acting as a single giant purchaser will lead to price controls on prescription drugs, which they say could slash profits and hurt future investment in research.

        To many seniors concerned about Medicare, the issue is less about what the candidates say during the campaign and more about which one has their interests close to heart.

        Tom Peelen, a 70-year-old Pleasant Ridge resident from the Netherlands who cannot vote because he is not a U.S. citizen, said it's a shame that prescription drug coverage ever wound up as a campaign issue.

        “This is such a terrific country with so many resources. But the politicians don't take care of the people,” he said.

        To make his point, Mr. Peelen held up a bag of medications he just purchased at Mullaney's Pharmacy in Pleasant Ridge. “This cost me $79.23. In my country ... zero.”

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