Introduction

INTRODUCTION
5
began appearing in the paper. Senior citizens began sending me handwritten
notes. Many came on personal stationery, a touching reminder of
a fading era when people penned longhand notes to their representatives
about matters that deeply concerned them.
The letters all spoke to the issue that bedeviled and eventually stalemated
the Medicare commission. Why, my elderly readers wanted to
know, were the prices of drugs so high Why couldn’t the government do
something about it And why couldn’t the government provide a prescription
drug benefit for senior citizens While 62 percent of Americans
take no drugs at all over the course of an average year, three-fourths of
the elderly do, and half of them take two or more that require them to
follow a daily regimen—usually for chronic conditions like high blood
pressure, diabetes, or arthritis. In 2002 the nation’s total prescription
drug spending soared to more than $160 billion a year and was rising at
an 18-percent annual rate. Americans spent more on prescription drugs
than on telephones, radios, televisions, and cell phones combined. Well
over half of that came out of seniors’ pockets. In the richest nation on
earth, some elderly Americans were hobbling onto buses to cross into
Canada to buy cheaper medicines, while others sawed pills in half or did
without basic necessities to get to the end of the month. 4
There were no significant differences between Republican and Democratic
appointees to the commission on the need for adding prescription
drugs to Medicare. Everyone agreed that pharmaceuticals had become a
key component of modern health care, just as hospital stays and doctor
visits had been the main concern when President Lyndon B. Johnson
signed Medicare into law in 1965. Yet, with the price of drugs skyrocketing
year after year, millions of seniors were forced to choose between
paying for their medicine and paying for the other necessities of life.
Leaving Medicare without a drug benefit would turn a program that was
designed to provide Americans with medical security in their old age
into a mirror image of the nation’s health insurance market. A substantial
minority of the population would be forced to go without.
Yet the appointees to the bipartisan Medicare commission faced a
conundrum in trying to add a prescription drug benefit to the system.
How could the government afford to add drugs to a program that was
already headed for bankruptcy Although the state of the economy over
this decade will determine Medicare’s ultimate date with insolvency, the
government’s actuaries predict the program will begin running chronic
deficits just about the time the Baby Boom begins retiring in 2010.
Liberals and progressive Democrats in Congress offered one possible