Improve Medicare First

Article excerpt

Much of the discussion about adding a prescription-drug benefit to Medicare seems to take place in a vacuum.

The healthcare program for the elderly is in serious financial trouble. The retirement of some 77 million baby boomers, which will put unprecedented stress on the program, is only a few years off. The Kaiser Family Foundation estimates that if nothing changes, Medicare will balloon from 12 percent to 25 percent of the entire federal budget by 2025.

Tacking a prescription-drug benefit onto the program without reform only ensures the problem will worsen faster. Yet that's exactly what congressional Democrats propose: Their plans would cost Medicare another $600 billion to $900 billion over 10 years.

The first question in this debate ought to be: How deep is the need for a prescription-drug benefit? The Concord Coalition argues that three-quarters of the elderly already have such coverage: through retiree health plans, Medicaid or other government programs, Medicare HMOs, and Medigap insurance policies. The Department of Health and Human Services reports that only 2 percent of the elderly said they couldn't obtain a needed prescription during the course of a year.

But for those elderly poor who rely on expensive drugs for their serious health problems, the hardship is growing. In constructing a drug-benefit add-on to Medicare, the focus should be on how to help those people who actually need help. Why spend billions giving a benefit to everyone, regardless of need?

President Bush's plan, to its credit, tries to address the entire Medicare picture. It would provide a new prescription-drug benefit while at the same time beginning Medicare reform. The plan, which would cost $400 billion over 10 years, would give seniors three Medicare choices:

* Stay in traditional Medicare and receive a discount card for 10 to 25 percent off drug purchases. After a patient has spent an unspecified amount (probably several thousand) in a year, additional coverage would kick in.

* "Enhanced Medicare," which would subsidize seniors' payments into private plans that would offer a drug benefit. This would mirror the quite successful healthcare plan currently provided to members of Congress and federal employees.

* "Medicare Advantage," an update of the current Medicare+Choice managed-care program, which may or may not have a drug benefit. …