Here Comes Trouble: Stories from My Life

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Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

December 19th, 2011 4:22 PM

Un-Happy Holidays for Seniors and the Disabled – Here’s Your Donut

It isn’t sugar plums dancing in their dreams for America’s seniors and disabled who are covered by the Medicare program.  It’s donuts.  Donut holes into which many fall at this time of the year as they reach the maximum limits of the first tier of “Part D” prescription drug benefits.

I watched my 67-year-old husband trudge up the driveway on a recent morning as I pulled away.  He had just showed me the printout of his drug costs for the year.  He’s reached the Medicare Part D donut hole by using more than $3,000 in prescription benefits.  He is disheartened because  his costs tripled at just the time of the year when grandfathers like to be thinking about other things instead of how to manage the cost of their prescriptions or which drugs can be cut in half and still do some good to get through to January 1 and a new benefit year.

And it’s not as if those drugs had negotiated prices that would make it a fair playing field for Medicare beneficiaries.  No, no.  When Part D was put into place, Congress didn’t see fit to allow the Medicare program to negotiate for lower drug prices.  You might think $3,000 sounds like a lot in medication costs, and it is until you fully understand that the prices are inflated as far as possible without any negotiated rates.

 So it was a donut hole for the sick and the elderly.  Reach it and you are on your own to pay for all of your drug costs until you reach the other side of the hole – or die because you could not afford to pay for those medications.

My husband’s $300 a month supplemental plan  doesn’t help much or at all on most of the donut hole costs, so before folks judge him and millions of others as irresponsible  and think they should be prepared for the costs, think again.  Many pay40 percent or more of their retirement income out in healthcare costs even after buying plans marketed to keep them protected.  Corporate America is making sure seniors and the disabled who rely on Medicare spend as much of their plan benefits and retirement funds on their profits.  Not much “Ho, Ho, Ho, Merry Christmas” in that.

My 84-year-old mother called me last weekend worried about the beginning of 2012.  She’s also on Medicare and a supplemental plan.  She reached her donut hole last week too.  But her bigger worry is the New Year when she’ll have to meet the drug and supplemental plan deductibles she has though her fixed income will not be changing.  “How will I get my puffers?”  She explained that one is as much as $400 when she pays out-of-pocket.  She worries about paying her rent and buying her groceries during those weeks until she has paid for the medications, submitted her claims for reimbursement from the supplemental plan and finally gets a partial check for coverage.  She worries.

My income is the back-up plan for both of them.  Without me, my husband says, he’d be dead.  My mom never knows if I’ll have enough to send her enough once I help pay my husband’s costs.

It is hard to imagine the kind of selfishness that allows our elders to worry so after decades of hard work and decades of paying taxes.  It’s not as if my mother didn’t earn her keep all these years.  She worked through World War II when times were tough for her family, and then in 1954, she contracted polio.  She was very ill for some time and even spent time in an iron lung trying to survive and heal.  She worked outside our home the whole time I was growing up, so she paid into Social Security for many years.  My dad too.  He also had a pension plan through his employer (ironically he worked as a pharmaceutical salesman), and he set up all that he could to keep my mom safe after he died.  They did all they could do to plan for their retirement years.

But as my mom struggles to get her medications and worries about co-pays and deductibles, rent, utilities and food, the company my dad worked for has morphed through several huge buy-outs and legal entanglements (the IUD deaths in the 70s, phen-phen diet pill deaths in the 80s, and beyond).  The company had to find a way to survive and keep profiting, so they cut pensions for retirees and survivors, they cut benefits, and they sold out the dead who helped build their empire of greed.

My mom’s worries this holiday season are not shared by the CEOs of the drug companies profiting off Medicare Part D and the donut hole.  It is yet another example among many of why our system is so corrupt – profit rules over people.   It breaks my heart and makes me mad.

I’d write shame-shame, but I’d say they’re a little beyond shame, wouldn’t you?  Someday when we finally reach the point where a progressively financed, single standard of high quality care is guaranteed for all, we won’t leave our seniors and the disabled worried and upset for the holidays.  Perhaps we’ll decide to honor them a bit more than what we have so far.

In the meantime, this holiday season if you know someone who relies on some combination of Medicare and supplemental benefits to help with their medical costs, ask if they need some help.  Because many of them cannot join up out at “Occupy” sites and weigh in that way (though I’ll bet many would if they could) and because the people they elected to protect them aren’t too interested in this issue right now as they rush to get home for the holidays.  Seniors and the disabled who have slipped into the donut hole aren’t on the radar this year – at least not until it’s turn-out-the-vote time.

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