For years elders attending senior centers or becoming members of elder groups have traditionally followed the recommendations of the group or the agency. This has given tremendous power to those organizations that could claim when it came time for elections, writing campaigns, sending emails or supporting politicians, that the agency or the group influenced hundreds or millions of elders. This is what is known as political capital and elders have been an important political capital for those agencies.
The Modernization of the Medicare program is discovering that the influence agencies, programs and organizations have on elders is diminishing because elders are beginning to second guess what others are saying is good for them. Of the 7.3 million projected elders that would enroll in the Discount Card program only 700,000 have done so. This number does not include the number of elders who are members of an HMO, those Medicare recipients were transferred automatically without their full consent or even knowledge.
Not even AARP, with an estimate of 23 million “real” members and 32 million “alleged” members has been able to enroll more than 400 Medicare recipients in one of 40 or so nationally approved Discount Card Programs. While there are 40 or so national programs in our individual states there could be 65 or more programs just targeting the local or regional Medicare population.
Why are elders not enrolling in the Medicare Prescription Drug Program? This non enrollment is of course very disturbing to the Budget process because the administration has used the projected number of enrollees to present the 2004-2005 Medicare budget, and if the enrollment does not catch up soon, serious and deep budget cuts would have to be made to other parts of the Medicare program like Part A Hospital and Part B Medical coverage. Doctors and Hospitals will be affected in the reimbursement rate they receive for their services.
There are several reasons why elders are not enrolling in the program, but the most compelling one is that it limits choices and makes elders captive of a company or a pharmacy for at least one year. This captivity is against the spirit of our culture which is based on freedom to choose, freedom to move around and freedom to express opinions and desires. This captivity also means that if the pharmacy or company decides to drop your medication from the list or increase the cost of your prescription you have no choice but to stay with them until the year is over.
The lack of enthusiasm about the prescription drug program has forced organizations like AARP to support the Re importation Bill and to investigate the artificial increases the pharmaceutical companies have done to the most popular prescription drugs used by elders. The support for Re importation bill comes several months too late. The Re importation Bill is still being debated as of this writing. Its future, while bright, may be limited due to the fact that American pharmaceutical companies began this month to limit the distribution of drugs to Canadian pharmacies. If Canadian pharmacies are not able to obtain enough supplies to re import medication to the US at a more affordable price, the re-importation bill may be a moot action. It has been said that AARP is supporting the Re importation bill because 80,000 members have objected to AARP’s position in regard to the Medicare Modernization Act. The 80,000 members’ objection became obvious when they dropped their membership in the organization.
If there is a need to enroll 7 million participants it is very possible that the only ads we will see on TV with the exception of political ads this summer is advertisement about the Prescription Drug Discount Cards. While the ads on TV make it sound as easy as showing a piece of paper to your Pharmacist the reality is much more complicated.
Because participants are being enrolled automatically it is important for you to first find out if you are one of those individuals that has no choice and therefore whether you are thrilled about the program or not you are already in the program. If you are a Medicaid and Medicare recipient you have been enrolled in the program without your knowledge. The same is true if you are a member of an HMO. You are also in danger of losing your freedom to chose if you attend a senior center and your activity director, social worker or the president of the senior center is pushing for your enrollment in the program. Make sure you don’t sign papers that you don’t understand, make sure you read the fine print before you commit the next year of your life to a program that may not be the best for you.
As a general rule if you don’t live in one state the entire year you should not sign for a program that may not cover your two places of residence. If you have a special condition that requires special medication only produced by one company be very careful and wait until the dust settles. More importantly, wait until you see what is going to happen with the Re importation Bill. I would rather buy my medication from Canada at a discount rate than limit my options too early. I would rather keep my freedom to choose than blindly accept the hearsay of centers, companies and organizations that for years have been using my political capital as their own. I am proud that elders are finally becoming their own independent agents.
Dr. Gema Hernández
