The Age of Entitlement:
Medicare and Prescription Drug Benefits
by E. Noel Preston, M.D. 
email: www.whuffodat@hotmail.com

   At the very start, let me say I'm a doctor and I'm in favor of a Medicare prescription drug benefits program. But, as a father and a grandfather I do not want such a program to be financially irresponsible. I do not want it to bankrupt the country. I do not want it to put our future generations into never-ending debt. I do not want the cost of a prescription drug program to weaken our military, keep us from building and repairing our interstate highways, defending our airports, or maintaining our national parks and monuments. 
   I am afraid that whatever prescription drug program Congress passes will be wrong. This is because the country is obsessed with the idea of "entitlement," and everyone is forgetting the cardinal rule of managed care: The only way to avoid financial loss is to restrict utilization. To a managed care bureaucrat, the ideal world would be one in which patients never went to a doctor or hospital, doctors never wrote prescriptions or ordered CT scans, and patients never needed wheelchairs or ambulances. Of course, this idea sounds ridiculous to doctors and patients, but the facts of life are that everything costs something, and the country can't spend its entire budget on healthcare.
   When I was an Air Force pediatrician, I would recommend over-the-counter medicines for a child's runny nose, but the father (usually an Air Force Staff Sergeant) would say, "Doc, if I get the Triaminic it'll cost me three bucks, but if you give us a prescription for Actifed I can get it for free at the hospital pharmacy." For a few weeks I would tell parents as gently as I could their children weren't sick enough to need a prescription medicine, and then the parents would report me to the Hospital Commander for being rude. The Commander, who didn't want anyone complaining to his superior, would invite me into his office to explain what had happened. After a few times sitting in the Commander's office, I decided, "So what? Let the jerk have the Actifed," and I wrote the prescriptions - lots of them.
   So just imagine what's going to happen when an Entitled Senior with a bad shoulder aggravated by a faulty golf swing is at the doctor's office: The doctor says, "You have an inflamed shoulder and you need to take an anti-inflammatory drug like Motrin." Entitled Senior says, "Doc, if I get the Motrin it'll cost me ten bucks, but if you give me a prescription for Celebrex I can get it for free from Medicare," And there's a whole lot more than a Hospital Commander - there's an entire Federal bureaucracy for Entitled Senior to complain to if the doctor doesn't oblige.
   Without some way to discourage utilization, the Medicare prescription drug program will eat like a ravaging cancer through the entire Federal budget and bankrupt the country. One way to discourage utilization would be to have a deductible amount patients would have to pay before they could receive benefits. This might work for a short time, but after people reached their deductibles there would be no stopping their requests for prescriptions when plenty of over-the-counter medicines would work just as well.
   What would work better would be to require a co-payment for each individual prescription that would be at least as much as the cost of the average over-the-counter non-prescription medication. That way, Entitled Senior would pay ten bucks either for the Motrin or the Celebrex.
   And to keep Entitled Senior from opting for the Celebrex anyway, it would be a smart idea to put an annual cap of $3000 or $4000, or whatever, on prescription drug benefits. This might keep people from blowing their benefits on Viagra when they might need them later for Lipitor, Plavix, or Procrit.
   Also, if there is a Medicare prescription drug benefit, what's to stop large companies like Coca-Cola, IBM, and General Electric from canceling their current prescription drug benefits for retirees and throwing even more thousands of people into another government program?
   Lastly, some of our senior citizens need help paying for their prescriptions, but not all of them do. There should be a means test to determine eligibility for a prescription drug benefits program. 
   But will Congress pass a sensible Medicare prescription drug program? I'm afraid not. This is, after all, the Age of Entitlement. But we can hope.

(E. Noel Preston, M.D. is only months away from becoming an Entitled Senior himself. He practices solo pediatrics in Norcross, Georgia.)

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553.

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