Medicare Prescription Drug Benefit Realities

David K. Cundiff

Disclosures
In This Article

Non-Drug Treatment Alternatives

Instead of Medicare paying for the expensive patented antihypertension drugs, it should fund supervised lifestyle change programs, including those with the "DASH" diet. The DASH diet alone lowers blood pressure by 11.4/5.5 mm Hg[28] without the metabolic risks or other side effects of antihypertensive drugs.

Other medications with questionable efficacy and/or safety include SSRIs for depression,[29,30] antiosteoporosis drugs,[31] anticoagulants,[32,33,34] thrombolytics,[35] weight loss drugs,[36,37] and COX 2 inhibitors.[38,39]

Since the aforementioned analysis of Medicare health outcomes and costs shows that more than $2.3 trillion will go to unnecessary services from 2006-2015 (including $1.2 trillion of Medicare money),[2,40] we should not be debating about spending $400 billion more for no significant benefit to Medicare recipients. Instead, we should be debating the merits and faults of competing proposals about how to comprehensively restructure Medicare or the entire healthcare system. The Physicians' Working Group for Single-Payer National Health Insurance recently reinitiated this debate.[41] Competing private managed care plans are not more cost effective than fee-for-service Medicare and won't control technology costs. Comprehensive healthcare reform proposals should limit out-of-pocket costs. They should also cover: (1) 100% of essential drugs, (2) a new health promotion benefit to reduce reliance on drugs, (3) long-term care and mental healthcare, (4) rehabilitation, and (5) first rate hospice care -- all for no more than we are currently spending.

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