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Bush’s Drug Card Lottery

by CHRISTOPHER BRAUCHLI

“The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.”

Sir William Osler, Science and Immortality

Just when you think it couldn’t get any better, it got better. The month of June brought us not only the Approved Prescription Drug Discount Cards program but a lottery.

Drug discount cards are almost as exciting as the 52 playing cards the administration issued at the beginning of the Iraq war in which the most wanted Iraqis found their likenesses on a deck of playing cards and the game was to see how many of the faces on those cards could be captured. It was a clever device and an easy way to keep track of who’d been arrested. (At last count all but 12 have been captured and the game is almost over, except for the violence.) The drug cards are, of course, different and the game has just begun. They offer seniors savings on drug purchases. They have only a couple of drawbacks.

According to the House Government Reform Committee, in many instances seniors will pay more for the drugs with the cards than buying drugs retail. The committee discovered that a one month supply of the ten best selling brand name drugs would cost more if purchased with a card offered by Pharmacy Care Alliance than if the same drugs were simply bought retail at Drugstore.com. The other drawback is that there are 72 cards from which to choose and each covers a different group of drugs. Once a participant has bought a card because of the selection of drugs and prices offered by that card, the purchaser is locked into that card until fall of the following year. The card issuer has slightly more flexibility. It can raise the price on those drugs in order to increase its profit. It cannot, of course, raise its prices willy nilly. Price increases can only occur once each week. That protects the consumer.

The cards could have been made better. In addition to limiting price rises to once a week, the democratic version of the bill could have been adopted. It required the Secretary of Health and Human Services to bargain with drug companies on behalf of all 40 million Medicare beneficiaries in order to obtain lower prices for drugs, the savings being passed on to the consumer. Under the enacted Bush administration version of the bill, the Secretary is prohibited from negotiating lower drug prices. Each card issuer can negotiate its own prices but there will be no collective bargaining.

Those taking more than one drug will have to try to figure out which card offering which drugs will be most likely to save the consumer money (assuming prices don’t go up after the card has been purchased.) Choosing a card will be like playing a game of “Old Maid.” The consumer may find that he or she bought the Old Maid and will be stuck with it until the next fall when the consumer has another chance to draw a card from the medicare deck.

As if the excitement of trying to buy a lucky card weren’t enough for the elderly, on June 24 the administration announced a lottery. Between 500,000 and 600,000 people will be eligible to participate and 10 percent of them will be selected. To be eligible to enter the lottery entrants must have cancer, rheumatoid arthritis, osteoporosis, multiple sclerosis and some other diseases. Congress appropriated $500 million for this program and the lucky winners will be selected at random. Forty percent of the funds will go to those taking oral drugs for cancer treatments and 60 percent will go to those with other illnesses. It is a preview of the benefits that will be available to all medicare participants in 2006.

Tommy Thompson, secretary of health and human services, explains that lottery winners “will save thousands of dollars on essential medicines that they can take home” and everyone who meets the eligibility criteria has an equal chance to win the lottery. The 450,000 to 550,000 people who need the drugs but don’t win the lottery will have to wait until 2006, assuming they live that long.

The losers may wonder what kind of a wealthy country establishes a program under which medicines to prolong life are only dispensed to the poor who win a lottery. Instead of carping they should be grateful that they don’t live in a third world country where there aren’t any lotteries to enter for medical care. As my mother used to say: “Eat your peas. Think of the poor people in Africa who don’t have any peas to eat.”

CHRISTOPHER BRAUCHLI is a Boulder, Colorado lawyer. His column appears weekly in the Daily Camera. He can be reached at: brauchli.56@post.harvard.edu

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