It was a bit of relief yesterday to get to work and settle in at my desk. Peaceful, even restful. I arrived there straight from the airport. Last weekend, it was our friend K’s semi-gruesome injury and a rushed trip to San Diego, this past weekend I flew up north to visit my aunt who was also having health problems, but of a different sort. She’s 79, and in pretty good shape for the shape she’s in, as they say. but she’s been having some trouble catching her breath, and feeling too tired to go about her daily activities. She and her husband live in Watsonville, a little (well, it used to be little) town soth of Santa Cruz. it used to be a town known mainly for growing strawberries and garlic, but in the past few years has slowly been turning into a ‘burb of Silicon Valley and the Bay Area. They live in a retirement apartment complex, on a fixed income made up mostly of social security and some small savings. Their only insurance is Medicare, and that is the point of this rant.

They are both on medications that are very necessary for their quality of life: he has Parkinson’s Disease and takes medication that helps control his falling down and instability. She takes medication to control her blood pressure and for depression. In both caases, Medicare does NOT cover these costs, and they are exorbiant (in some cases, each PIL can cost $50 or more!). What to do? Well, they can usually get a starter supply ffrom their doctor(s), but that only lasts so long. After investigating, we learned thta if you apply directly to the pharmaceutical companies, they will offer discounts if you can prove financial need (GlaxoSmithKline, for instance, offers the Orange Card plan – but I dare you to find an actual link to it on their website). These programs are not publicized, and require a great deal of patience and tenacity to join (and stay in, as most requirre that you re-verify eligibility every few months) – not qualities you’ll find in many older folks to whom the Internet is a vast wasteland and phone trees incomprehensible mazes of confusion.

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 by its very name sounds like relief has arrived at last. But here’s the skinny on it. Some huge holes to note:

• Allows drug plans to vary from the standard drug benefit (for example, from the $250 deductible, 25% co-payment up to $2250) as long as the benefit package offered is the “actuarial equivalent” (meaning it is estimated to be the same value) as the basic benefit.
• Requires beneficiaries to pay the full cost of prescriptions in what is known as “the doughnut hole,” a second large deductible, until a $3600 out-of-pocket spending cap is reached. The Adoughnut hole@ is a complete gap in coverage between $2,250 and $5,100 on covered drugs.
• Prohibits the Secretary of the Department of Health and Human Services (HHS) from negotiating prescription drug prices on behalf of all the more than 41 million Medicare beneficiaries as the Veterans Administration does.

Those deductibles may not sound so bad to me, or to you, but if you’re my aunt on a pretty tight fixed income, those are vast sums. We all too often take things for granted. And one of the things I too often don’t even think about is my excellent health care coverage. When Chuck had his surgery last April, it became a parlor game of sorts to watch the bills roll in (we’d see copies, but not actually have to pay them). When we saw the total (in the six figures), we were shocked, and very grateful we had health insurance. This weekend again reminded me of how lucky I am, as my aunt struggled with some new health issues, and worried about having to go the hospital (happily she is okay after all). That any elderly person in this country spends even one DAY, much less many years, worrying about whether they can afford the medications they need to maintain at least some level of quality to their lives should be, it seems to me, a huge embarrassment to all of us. Meanwhile, check out the government’s health plan for federal employees. Pretty sweet!

As Pete Townshend (who’s SIXTY, boys and girls) sang all those years ago, “hope I die before I get old.”