Prescription for a Senior Healthcare Crisis

Nearly every Tuesday afternoon, my mother Wanda and her small circle of friends gather after their morning craft group for lunch. Maggie’s Café in Comer is one of their favorite soup and sandwich spots, where the low murmur of diner chitchat, clinking forks, and the drifting thrum of the Eagles perfectly muffle private conversations. The three ladies give their menus a perfunctory scan and place them on the table and wait for their server.

As much as they would like for this to be a normal lunch, none of them want to talk about the harsh reality of the empty chair at their table, at least not directly. Their friend Cleo has only been gone for three weeks after her second round with cancer, and so they instead talk about their grandchildren, travel, church activities and their Wednesday morning exercise class. But their conversation, like most days, inevitably turns to healthcare.

Barbara, who takes medication to control her heart and autoimmune diseases, reveals her latest dilemma. Her doctor wants to prescribe a $400 shot for high cholesterol every two weeks. Other pill-form protocols have been unsuccessful or give her unbearable joint and muscle cramps. She knows the drill on insurance and has already calculated minimum out-of-pocket costs after Medicare coverage. Since the 78-year-old lost her husband Jack three years ago to lung cancer, her limited income and rising medication costs make it difficult to stay in her home of 34 years. Until her doctor can find an affordable solution without harmful side effects, Barbara will go without the medicine she needs to control her heart issues rather than lose her home.

Likewise, Sue’s husband Dave was recently diagnosed with early stages of leukemia and lymphoma. Both in their mid-70s, the couple is justifiably scared of the potential financial and emotional fallout, especially after witnessing Barbara and Jack’s health ordeals. Their collective struggle with other ongoing health issues already necessitates at least one or more doctor visits a week. They’ve been able to manage until now, but what happens if Dave is prescribed medication they just can’t afford?

Wanda is a healthy, independent 80-year-old who, like Barbara, relies upon her daily medication to keep her blood pressure and cholesterol levels under control. Her Medicare Part D contracts with the private drug insurance company WellCare. Some of her medications swing from $3 to $68 any given month, depending on whether the prescribed drugs are brand name or generic, or if they cover them at all. The oscillating costs make household budgeting an ongoing challenge. She pays an average of over $300 a month for supplemental insurance through her state retirement plan and still has to pay about $150 a month for out-of-pocket costs after Medicare, if the generic brand is available. If it weren’t for her pension, she would really struggle to cover these costs.

At a time in their lives when they should be enjoying retirement, the stress of rising healthcare costs threatens the financial security of these three women. Without price regulation, pharmaceutical companies can charge as much as they want for drugs without justification. And that effects more than just our aging populations. It also impacts younger adults and families with children with mental and physical disabilities, heart defects, diabetes, cancer, and lung and heart disease, among a host of other diagnoses and ailments.

But I believe there is hope, if we can get Congress to agree upon a viable solution. Therein lies the rub. According to a recent story by the American Medical Association, the drug-price legislation named H.R. 3, the Elijah Cummings Lower Drug Costs Now Act, struggled to get through the House and has been sitting on the desk of the Senate to approve since before Christmas. The fight for a capitalist market versus the fear of socialized medicine is keeping the bill from moving forward. This is one of the reasons you see healthcare at the forefront of our 2020 presidential campaigns. You can read more about the difference between the House and Senate versions of the bill in a report by the Commonwealth Fund, which details drug price negotiation, manufacturer inflation rebates for Medicare recipients, and a Medicare Part D redesign.

If drug prices don’t scare you, this will: In 2018, about 16% of the U.S. population was 65 years or older. As the median age of America continues to rise, the U.S. Census Bureau predicts that seniors will outnumber children by 2035.

So that makes me wonder what my healthcare and insurance look like in 35 years. Will I be able to afford healthcare or a nursing home or elder care? What will be left for those of us who follow the baby boomers? Taxes can sustain our welfare for only so long, and cost regulation needs to come from somewhere. I think H.R. 3 is a good place to start—if it can ever get off the ground.

I don’t know about you, but when I’m 80, I’d really like for my circle of friends to be able to gather each week and talk about family and travel and not our struggle with affordable healthcare.