Health Insurance and Prescription Drugs

The setting was the local CVS Pharmacy department. I was among several others waiting our turn at the Pick-up station. A young attendant was collecting individual prescription bags for a customer who waited patiently at the counter. He appeared to be about sixty, gray haired and casually dressed. As she placed each small bag into a larger brown bag, she would ring up the cost. Finally, she announced the total: “One hundred and fifty three dollars and sixty five cents.” He looked down at the bills in his hand, then said with a puzzled expression, “I don’t have enough money for that.”

He did not raise his voice. Nor did he sound argumentative. And he did not seem to be aware of the people in line behind him. “The doctor’s office called in the prescriptions,” he said. He appeared stumped by the problem of what to do next. The attendant asked him if he wanted to remove some of the prescriptions from the total. He said, “Okay.” She then took one out of the bag, placed it behind her on the pharmacist’s shelf and asked if $45 less would help. He looked again at the bills in his hand and said “No. Not enough.” She took another bag out, recounted and said, “The total is now one hundred and two dollars and fifteen cents. How’s that?” He handed over his money, waited until she gave him his receipt, took the bag and left.

What I had witnessed kept playing through my mind. What were the two prescriptions that were taken out of the bag? Were they for him? For his wife? Were they more important than the other prescriptions he took home? And what would he do if he didn’t have additional dollars to make a return visit? I also thought about the attendant who was trying to help him through the dilemma. She was kind in her manner. But wouldn’t it have been wiser to ask him to take a seat for a few minutes while she shared the problem with the pharmacist, who could call the doctor’s office and determine the priority of the drugs he needed. Perhaps a three-month order could be cut to one month as a temporary measure. Or a generic could be substituted for one or more of the drugs. I wondered how many times this happens at drug counters across the country.

The cost of prescription drugs is one of the most important issues in the current health care reform bills coming forth from the House of Representatives and the Senate. Since 2003, when the Medicare Modernization Act was signed into law, voluntary prescription drug plans were to become a part of health care for millions of Americans. It actually took until November 15, 2005 for open enrollment to begin for what is called Medicare Part D. January l, 2005 was when coverage became effective. There had been a huge struggle over whether the federal government would be able to negotiate with the pharmaceutical companies over the cost of the prescription drugs. Consumer groups and health care advocates in Congress like Senator Ted Kennedy of Massachusetts argued vociferously for negotiation to hold down costs for seniors on Medicare. However, when AARP endorsed the bill, its passage became assured. There were angry recriminations from thousands of their members who quit the organization. It is worthy of note that AARP, the best known seniors group in the country, also has a separate branch that offers health insurance plans.

There are similarities and differences between the bills emerging from the House of Representatives and the Senate. Two of the most salient agreements are that there can be no exclusion for pre-existing conditions, and someone cannot be dropped from insurance coverage because of illness. The differences will have to be resolved during deliberations of members of the Conference Committee. One fundamental difference is that the House bill would include the federal government’s ability to negotiate the prices of prescription drugs with the pharmaceutical companies. The Senate bill headed by Max Baucus, who received the most money in campaign support from the big drug companies, does not have that provision. The House bill would also close the Medicare drug coverage gap known as the doughnut hole. People are now forced to pay the full cost of their drugs each year when spending reaches $2,700 until it exceeds $6,100. The Senate bill would provide for 50 percent discounts on brand-name drugs for people who reach the doughnut hole.

In a closely related health care reform matter, The Senate Commerce Committee, headed by Senator John D. Rockefeller IV of West Virginia, is pressing the huge insurance companies on the amount of premiums they spend on doctor and hospital bills contrasted with administrative expenses, marketing and profits. Rockefeller released a statement on November 2 saying, “The insurers need to tell us how they are spending their customers’ money. Are they spending it to make people well when they are sick and keep them healthy?” he asked. “Or is the money they charge going to profits, executive salaries, and to figuring out how to deny care to people when they really need it?” His tough statement accompanied the release by the Commerce Committee of an analysis of regulatory filings from the largest forprofit insurance companies, including Well Point, the United Health Group, Aetna and Cigna.

There are critics of President Obama and the time it has taken to reach the stage where health care reform has come farther than ever before. Hopes for a bi-partisan Congressional effort have not come to pass. The Republican party is now labeled as “The Party of No.” But the complex work, immense time and effort being expended by the Democratic leaders and members of Congress are on course. It may be taking longer than projected. The final bill will cover in detail all the changes and improvements to the current system. It will be available on the Internet for the American people to read if they desire. When a final vote is called for in the House and the Senate, it will not be perfect. But, it will be the first comprehensive Health Care Reform Bill ever passed and signed into law by the President of the United

States – an historic achievement.

Joyce S. Anderson is the author of “Courage in High Heels,” “Flaw in the Tapestry,” “If Winter Comes” and “The Mermaids Singing.” She can be reached at JSAWrite@aol.com.