Medicare Drug Benefit
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In one of several Perspective articles in the December 29 issue on the Medicare drug benefit, Bach and McClellan paint a decidedly rosy picture of the new prescription-drug benefit.1 Their apparent aim was to reassure nervous physicians that this monstrously complex program would not overwhelm either them or their elderly patients. Their statement that "some beneficiaries will have challenging questions and will probably turn to their physicians" is certainly an understatement. A more likely scenario is that large numbers of patients, confused by a daunting array of choices, will deluge physicians' offices with inquiries.
Although the authors believe that "physicians are uniquely suited to helping their patients . . . to identify plans that provide substantial savings," I would argue that busy physicians, already overwhelmed by paperwork, are in no such position. Physicians are trained to provide medical care, not to navigate government Web sites and insurance companies' formularies. The best advice physicians can provide to their patients is to call the offices of their elected officials. Perhaps when these officials are swamped by calls from perplexed seniors, Congress will find a way to fix the mess they have created.
Howard A. Cooper, M.D.
Washington Hospital Center
Washington, DC 20010
howard.a.cooper@medstar.net
References
Bach PB, McClellan MB. A prescription for a modern Medicare program. N Engl J Med 2005;353:2733-2735.
To the Editor: The series of Perspective articles under the rubric Medicare Drug Benefit is informative, but the articles fail to communicate the enormous problems confronting Medicare beneficiaries. Having been in practice and involved in research and teaching from graduation from medical school in 1950 until retirement in 1992, I was exposed to the physician's side of these issues. For several years, I have been a counselor (in the Senior Health Insurance Assistance Program) in Montgomery County, Maryland. The Medicare Part D Prescription Drug Program has generated fear, anxiety, and for many, very limited benefits. Bach and McClellan's concluding paragraph paints a rosy, unrealistic picture that the frail elderly people who consult our office cannot comprehend. Kravitz and Chang1 gently point out some of the failures of the program but do not capture the frustrated feelings of a vulnerable population. The mixed and generally limited benefits, coupled with the complexity, lack of standardization of policies, multiple potential loopholes, lack of prescription cost control, and the many unmentioned subsidies to providers of drugs and insurance, contribute to the current low enrollment in this highly acclaimed plan.
Arnold A. Lear, M.D.
8900 Wooden Bridge Rd.
Potomac, MD 20854-2447
References
Kravitz RL, Chang S. Promise and perils for patients and physicians. N Engl J Med 2005;353:2735-2739.
Drs. Kravitz and Chang reply: We appreciate Dr. Lear's point of view. Although we did point out some of the Byzantine complexities of the Medicare Part D program, the experience of the past few weeks has confirmed some of the critics' worst fears. As Dr. Lear states, many beneficiaries (and their providers) are worried, frustrated, and scared. We hope that our guarded optimism will one day seem more prescient than do such fears. At the moment, it appears that patients, doctors, and pharmacists are struggling with information overload and a panoply of poorly understood options.
Richard L. Kravitz, M.D., M.S.P.H.
University of California, Davis
Sacramento, CA 95817
Sophia Chang, M.D., M.P.H.
California HealthCare Foundation
Oakland, CA 94607
Although the authors believe that "physicians are uniquely suited to helping their patients . . . to identify plans that provide substantial savings," I would argue that busy physicians, already overwhelmed by paperwork, are in no such position. Physicians are trained to provide medical care, not to navigate government Web sites and insurance companies' formularies. The best advice physicians can provide to their patients is to call the offices of their elected officials. Perhaps when these officials are swamped by calls from perplexed seniors, Congress will find a way to fix the mess they have created.
Howard A. Cooper, M.D.
Washington Hospital Center
Washington, DC 20010
howard.a.cooper@medstar.net
References
Bach PB, McClellan MB. A prescription for a modern Medicare program. N Engl J Med 2005;353:2733-2735.
To the Editor: The series of Perspective articles under the rubric Medicare Drug Benefit is informative, but the articles fail to communicate the enormous problems confronting Medicare beneficiaries. Having been in practice and involved in research and teaching from graduation from medical school in 1950 until retirement in 1992, I was exposed to the physician's side of these issues. For several years, I have been a counselor (in the Senior Health Insurance Assistance Program) in Montgomery County, Maryland. The Medicare Part D Prescription Drug Program has generated fear, anxiety, and for many, very limited benefits. Bach and McClellan's concluding paragraph paints a rosy, unrealistic picture that the frail elderly people who consult our office cannot comprehend. Kravitz and Chang1 gently point out some of the failures of the program but do not capture the frustrated feelings of a vulnerable population. The mixed and generally limited benefits, coupled with the complexity, lack of standardization of policies, multiple potential loopholes, lack of prescription cost control, and the many unmentioned subsidies to providers of drugs and insurance, contribute to the current low enrollment in this highly acclaimed plan.
Arnold A. Lear, M.D.
8900 Wooden Bridge Rd.
Potomac, MD 20854-2447
References
Kravitz RL, Chang S. Promise and perils for patients and physicians. N Engl J Med 2005;353:2735-2739.
Drs. Kravitz and Chang reply: We appreciate Dr. Lear's point of view. Although we did point out some of the Byzantine complexities of the Medicare Part D program, the experience of the past few weeks has confirmed some of the critics' worst fears. As Dr. Lear states, many beneficiaries (and their providers) are worried, frustrated, and scared. We hope that our guarded optimism will one day seem more prescient than do such fears. At the moment, it appears that patients, doctors, and pharmacists are struggling with information overload and a panoply of poorly understood options.
Richard L. Kravitz, M.D., M.S.P.H.
University of California, Davis
Sacramento, CA 95817
Sophia Chang, M.D., M.P.H.
California HealthCare Foundation
Oakland, CA 94607