To the Editor: In one of several Perspective articles in theDecember 29 issue on the Medicare drug benefit, Bach and McClellanpaint a decidedly rosy picture of the new prescription-drugbenefit.1 Their apparent aim was to reassure nervous physiciansthat this monstrously complex program would not overwhelm eitherthem or their elderly patients. Their statement that "some beneficiarieswill have challenging questions and will probably turn to theirphysicians" is certainly an understatement. A more likely scenariois that large numbers of patients, confused by a daunting arrayof choices, will deluge physicians' offices with inquiries.
Although the authors believe that "physicians are uniquely suitedto helping their patients . . . to identify plansthat provide substantial savings," I would argue that busy physicians,already overwhelmed by paperwork, are in no such position. Physiciansare trained to provide medical care, not to navigate governmentWeb sites and insurance companies' formularies. The best advicephysicians can provide to their patients is to call the officesof their elected officials. Perhaps when these officials areswamped by calls from perplexed seniors, Congress will finda way to fix the mess they have created.
Howard A. Cooper, M.D. Washington Hospital Center Washington, DC 20010 howard.a.cooper{at}medstar.net
References
Bach PB, McClellan MB. A prescription for a modern Medicare program. N Engl J Med 2005;353:2733-2735. [Free Full Text]
To the Editor: The series of Perspective articles under therubric Medicare Drug Benefit is informative, but the articlesfail to communicate the enormous problems confronting Medicarebeneficiaries. Having been in practice and involved in researchand teaching from graduation from medical school in 1950 untilretirement in 1992, I was exposed to the physician's side ofthese issues. For several years, I have been a counselor (inthe Senior Health Insurance Assistance Program) in MontgomeryCounty, Maryland. The Medicare Part D Prescription Drug Programhas generated fear, anxiety, and for many, very limited benefits.Bach and McClellan's concluding paragraph paints a rosy, unrealisticpicture that the frail elderly people who consult our officecannot comprehend. Kravitz and Chang1 gently point out someof the failures of the program but do not capture the frustratedfeelings of a vulnerable population. The mixed and generallylimited benefits, coupled with the complexity, lack of standardizationof policies, multiple potential loopholes, lack of prescriptioncost control, and the many unmentioned subsidies to providersof drugs and insurance, contribute to the current low enrollmentin 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. [Free Full Text]
Drs. Kravitz and Chang reply: We appreciate Dr. Lear's pointof view. Although we did point out some of the Byzantine complexitiesof the Medicare Part D program, the experience of the past fewweeks 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 willone day seem more prescient than do such fears. At the moment,it appears that patients, doctors, and pharmacists are strugglingwith information overload and a panoply of poorly understoodoptions.
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
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