Medicare costs and a tale of two Texans

By Bonnie Rogoff

Some liberals will find any excuse, no matter how absurd or illogical, to attack President Bush. New Republic Senior Editor Jonathan Cohn's piece entitled "Dubya's Medicare Mess" is one example. The newly instituted Plan D prescription drug plan is barely a month old, and Cohn implies the implementation of the plan is a failure.

Mr. Cohn cites a long list of complaints and his sources are reputable beacons of "truth" such as the Washington Post and New York Times. Specific drugs are not included in the formularies. The poor and the elderly are waiting in long lines in hospital emergency rooms. Tens of thousands of people go to their pharmacies only to find out their drugs are not covered. The administration of the program is going poorly. By the time I finished reading the piece I needed a drug plan with Valium to calm my nerves.

An unnamed state official tells the Washington Post: "We had dialysis patients who were not getting medicines, pharmacies on hold for 60-plus minutes, some plans closed for the holiday." He continued: "One man called me — he and his wife were on 15 medications...He went in for 15, and he left with one."

Cohn's article changes course and becomes a tale of two Texans: Former President Lyndon B. Johnson v. President George W. Bush. As Cohn tells it, President Bush's plan should have had a smooth, easy transition phase because the Medicare system was already in place, thanks to Johnson. It was the innovative LBJ who had the impossibly difficult task of setting up the Big Society programs, including the Medicare program which did not exist prior to 1966. "Back then," Cohn writes, "the obstacles were even more daunting than they are today. Rather than simply adding a benefit for a relatively narrow class of services (prescription drugs), introducing Medicare meant establishing an entirely new insurance program in just 11 months." One might ask why LBJ and future Democrats did not envision a prescription drug plan, and why it took a Republican administration to get it enacted. Nevertheless, the implementation of LBJ's Medicare program was easy and efficient. Mr. Cohn offers a sweeping generalization:

"So what happened on the day that this complex program (Medicare) was implemented? Thousands of senior citizens simply went to the hospital and got the health care they needed." (italics mine)

My grandmother was among that lucky group of seniors. In July, 1966 after exhibiting indigestion symptoms, my grandmother was admitted to a city hospital emergency room where she was abandoned for hours while having a heart attack. When she was finally admitted she was given the wrong medication and died three days later. The misdiagnosis and delay in treatment came courtesy of an incompetent, inattentive city-funded staff. It happened to my grandmother and to others. Years later, I met someone who worked at that hospital in the 1960s. Negligence and patient deaths were routine.

Surprisingly, the Cohn piece ignores obvious demographic shifts from 1966 to the present. In "Medicare at a Glance," The Kaiser Family Foundation reports: "In 2003, Medicare covers 35 million Medicare enrollees ages 65 and over, and six million enrollees under age 65 with disabilities. These 41 million Americans comprise 14% of the U.S. population." With regard to past and future growth:

Since its implementation in 1966, the number of people with Medicare has more than doubled, with 39.6 million receiving Medicare in 2000, and is projected to double again by 2030, with an estimated 77 million receiving Medicare. (Kaiser Medicare Chart Book (2001) p. 3

Unforeseen in 1966 were the increasing number of disabled Americans under 65 who would eventually qualify and receive Medicare benefits. The American Journal of Public Health reported on this trend in May, 1981:

Although the US population increased by 10 per cent, the number of persons permanently limited in their activities because of health conditions increased by 37 per cent with a much larger proportion of those disabled claiming to be unable to carry on their main activity.

The issues today are a growing elderly and disabled population, baby boomers nearing retirement age, a greater variety of drugs to treat medical disorders and a small support system of younger workers to pay into the system. There are far more drug choices for every disease than there were in 1966, and it was inevitable that within the large classes there would be restrictions. Most drugs are covered either as brand names or generics. All it takes is a phone call to the CMS Medicare's customer service number to obtain information and join a Plan D or change to another plan.

President Bush's biggest problem is his inability to communicate his ideas to the public. No Democrat ever did anything to institute a federally funded drug plan. President Bush accomplished it. Seniors now have choices, and amazingly, Jonathan Cohn objects:

Seniors seem bewildered by having to pick from as many as 52 different prescription plans, each one with different premiums cost-sharing requirements, and lists of drugs covered. By contrast, Johnson administration officials had argued against inundating seniors with such options.

Cohn concludes his article by prescribing a New Deal approach to avoid "chaos" while solving all societal medical problems: "Protecting people was a job that only a robust and, yes, big government could do properly."

Quite frankly, President Bush has grown this government big enough and we conservatives do give a damn. And if you thought Democrats were the "pro-choice" party, it's been one hell of a Cohn job!

© Bonnie Rogoff