Medicare - A rush to a quick fix

Congressional efforts are picking up steam to provide major changes in the Medicare system, including reimbursements for prescription medications.

While prescription coverage is a major goal, there is another goal that is just as important: shoring up the system financially so it will be able to provide benefits long into the future.

The 35-year-old Medicare program was conceived as a way to make sure the nation's elderly had access to health care. At the time Medicare was established, the delivery of health-care services was far different and far less complicated than it is today. In addition, new medical treatments and medications have been developed that, along with other pressures, have increased costs substantially.

Any plan to provide prescription coverage, therefore, has to be viewed in the context of the already burdensome expense of the health program that so many of the nation's older population have come to rely on.

Privatization of some aspects of the Medicare program is a goal of the Bush administration, which also wants prescription coverage added to the program. The president's goal is to have a bill to sign by the Fourth of July.

A rush to make changes

Both the House and Senate are pushing to meet that deadline, but, in the rush, may be overlooking changes in the basic Medicare structure that would best serve the needs of Americans and keep costs affordable.

Among the changes being considered are higher deductibles. One plan would even apply means testing, which would require some of the nation's wealthier Medicare participants to pick up a bigger share of their medical expenses. Means testing has long been anathema to the social engineers in Congress, but it's time for some form of cost-sharing to get a serious review.

Some options being ignored

There are other ways to contain Medicare costs, but they are largely ignored. As publisher Henry J. Waters III observed in a commentary this week in the Columbia Daily Tribune, one way to provide more health-care providers at less cost would be to use more nurse practitioners to provide much of the primary care Medicare patients need. But medical doctors see this as a threat to their own income.

The push for prescription coverage under Medicare is based on several factors. One is the ever-increasing cost of prescriptions. As pharmaceutical research finds new miracle drugs, the cost of prescriptions soars. And the plain fact is that most elderly Americans in need of medical care are dependent on drugs that have been prescribed by their physicians. At the same time, American patients are paying the bulk of the research costs for new medications, resulting in the inequitable pricing of American-made drugs sold here and in other countries.

The Medicare system, like so many federal programs, is as much a creature of politics as necessity. Whether Congress can do right by Medicare by July 4 remains to be seen. A quick political fix is much more likely.