Tales From the Front

I wanted to share a real-life story that occurred in my office this week. This particular story is an example of how poor people can slip through the fraying safety net that now exists in America. Mr. “Smith” is in his 50’s and is a disabled maintenance mechanic. He is on Medicare disability and has Medicare Part D for his prescription coverage. He has numerous chronic illnesses including diabetes, hypertension, emphysema, high cholesterol, and osteoarthritis (to name only a few).

Over the holiday weekend Mr. Smith was hospitalized for a blood clot in his leg. Unless the blood clot in the leg is treated with blood thinners, the patient is at high risk for pulmonary embolus (where a piece of the clot in the leg is dislodged and travels to the lungs). This is often fatal. He stayed overnight in a local hospital, received appropriate care, and was discharged on Saturday. In addition to his daily medications (14! of them), he required two new medications to treat his blood clot. One is an oral blood thinner, Coumadin, and costs only 40 cents per day. Unfortunately, this takes approximately one week to be therapeutically effective. During that week, the patient requires Lovenox, a blood thinning injection (self-administered) once daily. This injection costs more than 100 dollars per day. His out-of-pocket expense would be 880 dollars. Mr. Smith could not afford the medication and did not get it. To add insult to injury, Mr. Smith had a relative who died of pulmonary embolus, so he was fully aware of the risk he was taking.

The problem, you see, is that Mr. Smith is currently in the “doughnut hole” for his prescription coverage under Medicare Part D. This is the gap in his coverage between $2,400 and $6,250. 100% of his drug expenses are out of his own pocket while he is in this gap. His Part D coverage will kick in again after that, and he will not have to pay more than 5% of his drug costs for the remainder of the year.

It didn’t have to be this way. The Medicare Prescription Bill was written by and designed for the pharmaceutical and insurance industries. As I have written before, every time a Medicare beneficiary has to pay for their prescriptions out-of-pocket they should curse the politicians who voted for it. (The vote was generally along party lines, with Republicans voting in favor of the Bill and Democrats against.) Furthermore, the Senate voted last year to block a change in the bill that would have allowed Medicare to negotiate drug prices. Again, the votes to protect the pharmaceutical and insurance industries (and screw Medicare beneficiaries and taxpayers) were generally along party lines.

As for Mr. Smith, he ended up getting his medicine. I called the hospital from where he had been discharged and I gave them two options: readmit Mr. Smith for 5 days (at a cost of $10,000) or find him some Lovenox. As it happens, the hospital has a “charity” fund, and they agreed to supply the medication. Speaking of charity, this is what can happen when the safety net depends on charitable contributions. Despite the best of intentions, charity care can be inconsistent. Often times, those who are most in need have no idea that charitable programs are available to them. There’s got to be a better way.

American taxpayers…want to know where your one trillion dollar entitlement is going over the next ten years? (Hint…it is not to the Mr. Smith’s who could really use it.) It will surprise no one to learn that prescription drugs most often used by older Americans increased in price by 6% during the first six months of the Medicare Drug program. This is more than twice the cost of living allowance for Social Security and greatly exceeds the rate of general inflation. The profits for the ten largest pharmaceutical companies increased by 27% (8 billion dollars) for the first 6 months of the Medicare Drug Bill.

Now you know.