Examining the Future of Medicare

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Confusion over the prescription drug plan is just one of many challenges facing Medicare and the seniors who depend on it. Dr. Gail Christopher says the drug bill — like Medicare itself — must be shored up because the people it serves have no other safety net. Christopher is vice president for Health, Women, and Families at the Joint Center for Political and Economic Studies in Washington, D.C.

ED GORDON, host:

Confusion over the prescription drug plan is just one of many challenges facing Medicare and the seniors who depend on it. President Bush's new budget proposal would trim the program's growth by $35 billion over the next five years. To help us better understand what's happening to Medicare, we're joined by Dr. Gail Christopher, Vice President for Health, Women and Families at the Joint Center for Political and Economic Studies in Washington D.C. She says the drug bill, like Medicare itself, must be shored up, because the people it serves has no other safety net.

Dr. GAIL CHRISTOPHER (Vice President, Health, Women and Families, Joint Center for Political and Economic Studies): The jury is very much still out. What we've seen is indeed a lot of confusion. People who are again the most vulnerable and this is the critical factor. When we talk about the dual eligible, those who have been receiving both Medicaid and Medicare, those are the people with chronic disabilities, people who have the greatest needs for medication. Ironically, they're also the least educated. We're talking about 62 percent of this population has no high school diploma.

So the complexity of both picking a plan from among anywhere from 50 to 80 plans within a given geographic area, to making sure that plan provides all of the medications or covers all the medications that you might be taking, that's very complicated, and it's uncertainly unnecessary complication for a population with these challenges.

GORDON: Well, with what you've seen so far, how many are actually falling through the safety net.

Dr. CHRISTOPHER: We'll have to monitor this, because it's only been in place for a couple of months. But I think the proactive efforts on the parts of many states who have put processes in place to protect those who were, in fact, falling through in this transition period, would speak to that being a major concern. And we have to applaud the states that stepped up to the plate and said our people will not go without the medications that they need.

GORDON: How much do you see that we're going to have to change Medicare and Medicaid to service the sheer numbers of people who are coming down the road?

Dr. CHRISTOPHER: There's no question that some our best minds and some of our best energy needs to go into redesigning these programs so that our country can both afford them and people can access the care that they need. The baby boomer generation is, as you know, here, and we're going to be using more of the Medicaid and Medicare services. So we do have to really get creative.

Most of the expenditures for both Medicaid, and to a large measure, Medicare are for long term care expenditures. We do not have a creative approach to that, and that's what needs to be done.

GORDON: The president's new budget proposes a $35 billion (that's with a B) dollar cut over the next five years. Can this sustain itself the way we know it? Can we see the changes that we were told by this government that were going to actually end up assisting seniors go into place without that money?

Dr. CHRISTOPHER: To use the term of today, that's going to slow the growth of Medicare, I think, from 7.4 to 7.2 percent. It's a very incremental slowing down of the escalation in projected cost. It will have an affect, however, on reimbursement rates to providers, on co-pays or premiums for seniors who have a little more income, and most importantly, it will affect reimbursement rates to hospitals. So these are going to be problematic affects for service providers, right down there where the rubber meets the road, where people are going to access services. This is where they're going to experience these cuts. This is not a creative approach to solving what is indeed a national challenge.

GORDON: How much do you believe that the American public has a true understanding of not just the change, but the system itself?

Dr. CHRISTOPHER: We're actually doing a survey on that. The results are not in yet at the Joint Center, but there is a high level of confusion. It's confusion amongst the lay person. It's confusion among the leaders themselves, the elected officials. There is a lack of understanding about the basics of these programs. We have people confusing Medicaid with Medicare and not knowing the difference between the two.

You add to that a literal industry, a cottage industry that's emerged to handle the prescription drugs--and let me say that it's not a bad idea that our nation decided that prescription drug coverage, which heretofore had not been a part of Medicare, that it become part of Medicare. I think that that's to be applauded. What is a bad idea is the way it's been designed and certainly implemented.

GORDON: How close do you believe this country is in finding a way to make real, quality health care affordable to everyone?

Ms. CHRISTOPHER: Now, that question has many dimensions, and quality is certainly a key factor, and we forget that.

GORDON: And that's why I added that.

Ms. CHRISTOPHER: We'll get back to that, but if you think about, we do spend more than many developed nations on providing access to care through our Medicaid program or Medicare program and the CHIP program for children, but we are still the only developed country that doesn't provide some form of universal access.

I think, and hopefully in our lifetimes, we will see that change. What we find is that...

GORDON: What would you tell those who are looking at still needing to deal with their situation? What would you suggest they do?

Ms. CHRISTOPHER: People are going to need assistance, and they shouldn't be afraid to ask for it, through their churches, through non-profit organizations, even family members. This is difficult. It requires access to a computer in most cases. It requires a sophisticated ability to navigate these various programs, and so reaching out and asking for help, savings can be there for people if they have someone who understands the prescription drug formularies, the language, who can provide the guidance that people need. So my greatest recommendation is that people should not be afraid to ask for help from either a family member or ask that family member to access help from a public source or a non-profit agency.

GORDON: Nor should they be afraid to go to a church or another social organization--or a social organization, I should say--and ask them if they're not involved to get involved.

Ms. CHRISTOPHER: Absolutely. This is so important, and our community--if you think about it, African-Americans-42 percent of African-Americans are uninsured. And so we need our leadership organizations, be they churches or non-profit groups, or sororities, or fraternities, we need much more proactive leadership and coaching and support for individuals as they navigate what is an unequal healthcare system.

GORDON: All right. Dr. Gail Christopher, vice president for Health Women and Families at the Joint Center for Political and Economic Studies in Washington, D.C. Thanks so much for joining us.

Ms. CHRISTOPHER: It's been my pleasure. Thank you.

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