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One thing that's sure is the Part D drug benefit was supposed to be a center-piece of the Bush administration's domestic agenda. As originally envisioned, Part D would give relief to millions of elderly Americans facing skyrocketing costs for prescription medications.
The pundits and spin doctors have had their say. We wanted to hear from people in the trenches who deal with Medicare on a daily basis. We also had the opportunity to talk with a few current and past policymakers about their opinions of the program.
DOC News asked:
How is Medicare Part D helping patients?
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Many of my patients are the poor and elderly. They are covered by Medicare or by Medicare/Medicaid. All of the latter group were put into a Part D plan automatically on January 1. They had no choice in the matter—if they did, they weren't told about it. All of them had to pay co-payments they didn't have [to pay] prior to January 1. Some of them couldn't get the medicines that had served them well for years. No intervention on my part helped. I wasted a lot of time on the phone and writing requests.
Some of my financially better-off patients noted that their retail medicine costs had risen or that they were required to change to a different medication in the same class. I had only two positive comments from patients who were on a large number of very expensive medicines. Even with the glitches fixed, the program has problems. It's too complicated, it will put the independent pharmacies out of business, the poor shut-in patients will no longer have their medicines delivered to their home, and we are all at the mercy of the profit-oriented insurance and pharmaceutical industry. I grade Part D with an F.
Melvin H. Kirschner, MPH, MD Family Practice Van Nuys, Calif.
Working at a community health center, my encounters are with patients with no insurance, Medicaid, Medicare, and some private insurers.
Those who qualify for Part D at Medicaid income levels seem to have the best deal, with medications at a very low co-pay. The others experience a much higher co-pay. Thus the same problem of [choosing] food versus medications still exists for a large number of citizens.
I use Epocrates in my PDA [personal digital assistant]. With the PDP [prescription drug plan] programs available for downloading to the application, this has reduced the pharmacy phone calls regarding noncovered medications.
So, I would give Medicare Part D a D and Epocrates a B+.
Paul Nault, MD Family Practice Prescott, Ariz.
So far it seems like a nightmare. Patients are confused. As patients get ready to have their prescription renewed, what we are doing is refilling all their prescriptions. Where this ends, and what happens after that, I have no clue. How they select the plan and how long it takes for them to get the prescription and if the renewal is smooth and easy—we don't know yet.
[Patients] don't know what to do. I think the person who is helping them the most is their pharmacist. How they decide which plan to guide them to, I don't know.
Dhirendra S. Bana, MD Internal Medicine Boston, Mass.
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It's coming in about 30% less expensive than expected. It's gradually being accepted, and it will eventually be a reasonably successful program. It had some teething problems because CMS [Centers for Medicare and Medicaid Services] is not used to talking to Americans in consumer language, and there was an amount of unnecessary difficulties.
Newt Gingrich Political Scientist Washington, D.C.
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We call it Part D for "disaster."
Patrick Kennedy (D-R.I.) U.S. Representative Washington, D.C.
TALK BACK: THE TOXIC ENVIRONMENT OF MODERN LIFE
Time and again, we hear from the medical and lay community alike that the obesity epidemic is driven by a variety of factors, including genetics, personal choice, and today's "toxic environment."
This environment comprises a variety of components with clear links to the energy imbalance that results in chronic weight gain. Long days at work, unsafe neighborhoods, even concerns about war and terrorism contribute to the stress and depression associated with overeating.
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Researchers often refer to sedentary lifestyles aided by modern amenities such as computer-based jobs, television, video games, automobiles, and escalators. Typical patterns of suburban sprawl separate work from school from shopping from home via car-friendly highways that make walking or biking nearly impossible. The availability and affordability of healthy fresh food (or lack thereof, influences of the food industry and its marketing power all play important roles in what people choose to eat.
Clinicians say it will take more than their good advice and treatment to turn back the tide of rising obesity. It appears it will take a village to reverse the lifestyle changes modern living has wrought.
What do you think? what could your community do to promote physical activity and healthy eating habits?
Send your comments to docnews{at}diabetes.org.
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