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Help Not Wanted


It's hard to see how to even qualify for any "benefit." In my case, I am a retired state employee who had a fine prescription drug policy negotiated by the state with a company that, to my knowledge, never questioned my physician's choice of medicine. Now I have a policy the state of Virginia moved me to that doesn't cover some of my prescriptions, and to a layman looks as if the insurance company is actually practicing medicine. There are, I am told, excluded drugs "which cost participants significantly more."

The insurers tell us, "If you find that you are taking a nonformulary drug, you may wish to consult with your doctor and/or pharmacist to determine if there are alternatives included on the formulary that might be just as effective in treating your medical condition."

A friend who is helping her parents work their way through the new "benefit" plan tells me: "ALL of my parents' drugs went from at least 75 percent to 100 percent covered to only 25 percent or not covered at all, one of which is for my mother's triglycerides. If she doesn't take it, she will stroke out. Sort of like that doctor who told my dad he needed to pass out a few times before they would even consider a pacemaker."

For many reasons, the understanding of which might keep me on the phone for 15 hours, this new "benefit" will also, according to budget projections printed in The New York Times, "show that seniors will face higher bills each year." A 10-year chart prepared by the Medicare actuaries estimates the drug premium will rise from $35 a month next year to $68 in 2015: "Annual deductibles will start at $250 in 2006 and rise to about $472 in 2015, and the maximum annual out-of-pocket expense would be $6,800 that year."

Part of the reason for the rise in cost is that in this country Medicare is prohibited from negotiating with drug companies for cheaper medicines that can be purchased for much less in other countries.

But back to the personal: In addition, the new company that has captured me has now sent a six-page questionnaire that I must fill out and promptly return. No, I do not have black lung disease. And no, I don't have workers' compensation payments.

Because I am what is euphemistically known as a "senior," I remember the introduction of new government programs from the 1930s on, and I don't remember the sort of confusion that is happening now.

If I were paranoid, I might believe that the opponents of social programs, having found they could not defeat the provision of help to seniors with drug costs, decided to make the program so complicated it would not work. So much for socialized medicine!

As Matt Bai wrote in The New York Times Magazine: The Republicans "who designed the new program in 2003 managed a spectacular feat of alchemy: They created a benefit that perfectly embodies the worst aspects of both dominant ideologies of the 20th century, combining an expensive and impenetrable government bureaucracy with an unseemly concern for corporate profits."

When I turn on the television, I can't seem to escape the ads for the wonderful plans seniors can choose from — more than 40, I believe. Maybe we should be grateful the state has made our "choice" for us. But as far as I can tell from the state communications, Virginia has added to that by moving its retired workers into a new program that is decidedly not a "benefit" to many of them, and to ensure that we stay in this plan and don't try to return when our drug lots increase.

I can't wait for my next benefit. S

Rozanne Epps is copy chief at Style Weekly. She retired from Virginia Commonwealth University in 1986 after 21 years of service.

Opinions expressed on the Back Page are those of the writer and not necessarily those of Style Weekly.


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