By Joel A. Moskowitz, M.D

For the average Medicare recipient, Medicare Part D is a dilemma.  For low-income persons who previously were dually covered under both federal  Medicare and California's  Medi-Cal, U.S. Congressman Bob Filner (D-San Diego)  asserted that the  "D" in Part D stands for 'disaster!'

At a Jan. 20 news conference at the Kimble Senior Citizens Center in National City, doctors, patients and politicians spoke with one voice decrying the misguided medication plan.  Congresswoman Susan Davis (D-San Diego)  echoed the serious impact of this government program calling it a (pharmaceutical) "Katrina".

The toll is particularly hard on those dependent on expensive or multiple medications. Previously a person on California's  Medi-Cal program would receive these drugs without cost.  With this new plan, individuals with life threatening and chronic diseases and limited finances are being obliged to pay co-payments which they can ill afford.

A vision- impaired man spoke to those assembled describing how he is being forced into a situation where he won't be able to pay for his food. Proper nutrition is an essential-especially when an individual is suffering illness. Part D can be bad for your health.  Complicating the chaos are instances where the seriously ill person arrives at his/her pharmacy only
to be told there is no evidence of his/her eligibility— presumably a computer program's sickness can result in the drug recipient becoming sicker.

As the program currently stands, it would appear that any participating drug plan can change its premium (undoubtedly raising it) or deleting 'covered' drugs at its own option.  The individual subscriber is prohibited from switching plans except for a yearly window.  Even for those who are not indigent, the plan has serious drawbacks.  Consider that even when your physician prescribes a 90-day supply for a medication which you are likely to take ad infinitum, the pharmacy has restrictions only to release a 30 day supply initially, at higher per pill cost.   

Although people requiring expensive pharmaceuticals, costing more than $5,100 year, are covered, persons whose pharmaceutical requirements are between the levels of $2,500 and $5,100 receive nothing under the standard coverage. Some plans offer to fill in the gap by authorizing generic pharmaceuticals only or generics plus brands.

It has been suggested that a covert agenda of Part D is to force  low-income citizens to join a HMO (Health Maintenance Organization). Thereby this population group will no longer have a free choice of health care provider.  To be sure, physicians in private practice often complain
that attempting to care for patients with Medi-Cal is frustrating and there may be problems in finding doctors who accept the low fees and huge paperwork.  However, in a free society, choices, some would argue, should not be manipulated by legislative sleight of pen.  A significant part of any remedy is a positive doctor-patient relationship.  When the patient is forced to leave his/her doctor for a HMO, this could be an unhealthyprescription.

Poor bureaucratic planning is blamed for the confusion.  There are over 7 million "dual eligibles", (66,000 in San Diego County alone). These are low-income individuals who receive both Medicare and Medi-Cal.  About one  million are on Medi-Cal alone. For the disabled and seniors whose income is so low that they qualify for Medi-Cal, the new Medicare
Part D is no benefit.  

Choosing the 'right' plan is daunting for virtually  everyone.  In California there are about 19 commercial plans. each with different monthly premiums, and formulas that may or may not include all the drugs you might be taking. The commercial plan may not be acceptable
to the pharmacy where you customarily receive your medications.  Some drug chains have attempted to be helpful.  Walgreens has an 'in house' computer program, which they are making available to anyone without charge.  Bring a list of the medications you are taking and Walgreen will print out a list of the various plans and indicate which of these drugs any one plan
might be willing to pay for.

The State of California has asked the Federal Government for funds to help.  Prior to Medicare Part D, the State of California made drugs available to Medi-Cal eligible persons.   This was an expense of the State with part subsidized by the Federal government.  Before this bewildering
legislation, the State was able to negotiate cost saving deals with pharmaceutical manufacturers.  Under Part D, the 'buying' power of the State is bypassed.

The projected savings promised by the authors of Part D instead has become a losing proposition.  Governor Arnold Schwarzeneggar has been asked to set aside $150 million in emergency funds.  The argument that the State will save money because Part D provides  a $50 million dollar subsidy to California State retirees is rejected by officers of that organization.
Officials of Cal-PERS, the State Retirees organization, object to using these funds to solve the State's budget problems.

It remains to be seen if Medicare Part D is good for anyone's health.

More  information is available on: http://www.medicare.gov or by calling 1 800 633 4227.