Providing Drugs Under Medicare

* Re “There Is Merit in Adding Prescription Benefits to Medicare,” Commentary, March 10: There is little argument against adding prescription benefits to Medicare. The high cost for drugs has pushed many reluctantly to the HMO fold. What is debatable is the best method to provide them. It is difficult for me to understand why there is so much opposition to providing Medicare beneficiaries the freedom to choose through a voucher system.

Theodore Marmor, Mark Goldberg and Jonathan Oberlander are correct in pointing out that the rise in per capita cost for Medicare lagged behind even managed care. What they failed to appreciate is that the slower Medicare inflation is achieved through HFCA’s propensity to arbitrarily deny or lower payment on professional services for certain procedures. The consequence can be the elimination of treatment approaches, thereby creating yet more false saving.

Since there are already organizations such as the AARP to provide our Medicare population with drugs at reasonable cost, the voucher system would appear to be the least bureaucratic and intrusive.

JOHN T. CHIU MD

Newport Beach

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The authors make a very important point which is not consistently followed in their argument. It is true that Medicare was modeled after private insurance in 1965 and has not kept pace with changes in the private insurance market. While prescription drug coverage is much more common now under private insurance, so also is the “voucher” approach to health care benefits.

Most taxpayers have a choice at work: purchase coverage by an HMO or managed care organization or pay a hefty premium to remain in the unfettered fee-for-service system. If we follow the logic proposed, then the voucher system represents a long-overdue adjustment to Medicare, which will bring coverage for the elderly in line with private insurance, prescription drugs included.

JEFF McCOMBS PhD

Health Economist

USC School of Pharmacy