Medicare Dysfunction
Byline: THE WASHINGTON TIMES
Taxpayers have surely noticed Madison Avenue’s recent interest in erectile-dysfunction medications. This week they learned why: They will be footing the Medicare bill for Viagra and similar drugs. The coverage of what are by and large lifestyle drugs seems all-the-more disfigured at a time of fiscal belt-tightening.
Medicare and other publicly funded programs are geared toward providing critical health coverage, not treating erectile dysfunction. Yet Medicare administrators have fairly pointed out that they were simply following the 2003 Medicare law by including Viagra, Cialis and similar medications. According to the law, a drug must be covered by Medicare if it is “medically necessary” and has been approved by the Federal Drug Administration. Sexual-performance drugs can also be used to treat enlarged hearts that can result from high blood pressure. Furthermore, there was no provision in the law excluding sexual-enhancement drugs from coverage, as there were for weight-loss and fertility drugs, barbiturates and non-prescription medications.
The potential for abuse is vast. “Bureaucrats, isolated from fiscal responsibility, have made a thoughtless decision that will accelerate Medicare’s demise,” said Tom Schatz, president of Citizens Against Government Waste. Wage earners help pay for Medicare through payroll taxes.
Doctors are also shielded from the concerns about public spending, and have wide discretion to decide just what is “medically necessary.” Meanwhile, it is becoming increasingly clear just how expensive the drug-benefit portion of Medicare will be. On Tuesday, Medicare chief Mark B. McClellan said the bottom-line cost of the drug benefits package is estimated to be $720 billion from 2006 to 2015. In September, he said the package would cost $534 over 10 years and the administration had originally said the cost would be about $400 billion. In light of that considerable and mounting sum, the potential abuse related to erectile-dysfunction drugs is all the more worrisome.
Congress will have to do more than worry, though. Lawmakers will have to broadly review the potential for waste under the 2003 law and consider if new legislation is needed to rein it in, even if this means more narrowly defining the meaning of “medically necessary.”