Those balled-up, knotted handkerchiefs we see so many seniors unravel with their shaking hands at pharmacy counters to pay for their drugs will now have to contain thousands of dollars more.
The hankies are now tied to a controversial $400 million bill signed by President Bush Monday that adds prescription drug benefits to Medicare while making it "competitive" with HMOs. With a poll showing a majority of seniors finding the new procedures confusing, especially the eventual take-it-or-leave-it choice of an HMO or Medicare, the president declared seniors are "fully capable" of making health care choices.
Legislators and health policy activists, however, are beginning to ask how the word will flow out to those hard-to-reach, low-income Medicare users and those with Alzheimer's or other mentally debilitating ailments regarding the new regulations that kick off in 2006.
The new requirements include purchasable government discount drug cards, more out-of-pocket expenditures and a gaggle of new drug benefit programs managed by private insurers under contract with the government.
"Our government is finally giving older Americans better choices and more control over their health care," said the president at the bill-signing ceremony.
Critics have already fired off shots and several Democrats have moved to introduce legislation to repeal parts of the bill. Says Sen. Richard Durbin (D-Ill) of passage of the new Medicare procedures: "This bill does nothing to reduce drug prices, it leads Medicare down the road to privatization."
Under the new plan, seniors have the option of signing up for Medicare or a for-profit HMO and all the baggage that entails. Seniors who opt for Medicare will be charged a $250 deductible and 25 percent of drug costs up to $2,250. After this amount, Medicare will pay nothing until the senior spends an additional $2, 850 out of his own pocket.
Reps. Charles Rangel (D-N.Y.) and Elijah Cummings (D-Md.) both protested what they termed the "$2,800 donut" or out-of-pocket expenses Medicare users would have to fork over beginning in three years.
"This is projected to earn the pharmaceutical industry $139 billion over eight years," said Rep. John Dingell, the ranking Democrat on the House Commerce and Energy Committee.
The Congressional Black Caucus and Sen. Edward Kennedy (D-Mass.) led a fight to defeat the bill because of what they termed its "destabilizing effects" with its emphasis on private insurance companies and their captivity to profit margin ups and downs.
President Bush said he will sign the bill because he understands that the "lack of competition offers no real need to change the system. Seniors will now have options."
Randal Maxey, president of the National Medical Association, an organization of Black physicians, endorsed the bill "on balance," but acknowledged that the bill "does not address the health care needs of the poorest of the poor… and neither does it speak to the participation of African American and other minority physicians in the new regime of HMOs."
Democrats broke ranks in both the House and the Senate because of a last-minute controversial endorsement by the American Association of Retired Persons (AARP), an action protested by many of its members nationwide.
"Many AARP members make up the constituency of the switchers," said one Capitol Hill source.
With House Republicans twisting arms during an unprecedented three-hour floor vote to reverse a bill defeat of 218-216 to a win of 220-215, the Senate broke a filibuster with defecting Democrats and the bill rode in victorious for a 54-44 vote.
With cries of "a poison pill for seniors" and "a wolf in sheep's clothing" filling the air, Senator Orrin Hatch (R-Utah) waxed indignant: "We're putting $400 billion out there with this bill. We're giving seniors a choice in coverage."
Beginning next year a drug discount card will be made available to seniors that will reduce drug prescriptions by "15 percent." Seniors earning $12,123 or less (and couples earning $16,362 or less) will not be charged monthly premiums or the $250 deductible. In 2010, under the new bill, Medicare would have to compete with private companies in six undetermined urban areas to "test whether competition would drive down costs."
And it is here, critics contend, where Medicare will end and private, market-driven greed will take over. Sen. Tom Daschle (D-S.D.), the Senate's minority leader, has already introduced legislation to repeal parts of the bill that appear to doom Medicare. An old woman's trembling handkerchief can unravel just so much.