PARTIAL COVERAGE

Drug spending for American seniors over the next 10 years will total $1.8 trillion, according to the Congressional

Budget Office. That would make the president’s plan to spend $400 billion over that time for Medicare drug coverage and the overhaul of the entire system something less than a good start. But it is a start in the sense that the White House is aware that Medicare, to be considered health care insurance, must cover a broad range of prescription drugs.

President Bush softened his original plan to offer prescription drug benefits only to beneficiaries who switched from fee-for-service to private managed care. He would now offer limited drug benefits to beneficiaries in fee-for-service plans and full benefits for those who switch to private insurers. The difference is said to be an incentive to encourage Medicare recipients to switch to the private plans but, given the CBO estimate, it actually assumes that many of the 85 percent of recipients in the traditional public plan will stay there and receive only minimal benefits.

Other parts of the plan offer some encouragement. The president proposes to offer a $600 annual subsidy to low-income seniors for drug purchases and those who choose the private plan would receive preventive benefits such as cancer screening. Because the new drug benefit would not be available until 2006, the administration also proposed providing a discount card to reduce retail drug prices by 10 percent to 25 percent, an amount unlikely to stop the bus trips to Canada for less expensive drugs. But the major change to come must be the overall drug benefit, and Sen. Susan Collins reflected the sense of a majority in the Senate this week when she said she believes “that a Medicare prescription drug benefit must be available to all Maine Medicare beneficiaries. I therefore have reservations about tying the full drug benefit to participation in a managed care plan.”

Sen. Olympia Snowe called the administration’s plan a step forward but disagreed with the premise of pushing seniors into private coverage. “After all, seniors in my state of Maine currently don’t have access to HMO plans under Medicare+Choice or the Federal Employees Health Benefits Program (FEHBP),” she said. “I am concerned that under this plan if the private, HMO and preferred provider options don’t succeed, seniors will not have any fallback available under the traditional fee-for-service Medicare program, as they do today.”

She might had added that those currently paying for the plan through payroll deductions will not look forward to contributing to the profits of private plans, who could expect a windfall under the Bush proposal, and certainly will insist on tough price negotiations with drug companies.

Maine is not alone in lacking choice for seniors, and without choice the president’s plan to save the system money through competition is not likely to get very far. Prescription drugs will continue to become a more important part of the health care system; shutting so many seniors out of this part of the system doesn’t cure Medicare’s ills.