Now and again I am reminded of how many TGB readers live in countries other than the United States so let me first supply a short definition of the evil donut hole.
Part D is a supplement to standard Medicare health coverage which itself does not provide prescription drug coverage. Part D is a voluntary purchase for which consumers pay an extra premium but the cost doesn't stop there.
Without going into arcane details, in general, when the consumer's total out-of-pocket payments for drugs reach $3,750 in a calendar year, the “donut hole” kicks in during which the consumer pays a higher percentage for the drugs until his/her out-of-pocket cost hits $5,000.
After that milestone, the insurer pays all but five percent of the drug costs until the accounting starts over again from scratch in January of the following year.
Until I was diagnosed with cancer last year, the only prescription drugs I had taken were antibiotics now and then, the price of which was paid for by my health insurance so I had no idea how expensive many drugs can be.
I sure do now, having entered the donut hole about two months ago and from which I will emerge, if my calculations hold up, fairly soon.
Quick story: At the beginning of my chemotherapy treatment last fall, I was handed my first month's supply of the oral drug along with a piece of paper with a figure of $5,000.
At first I felt the blood drain from my head and then I laughed. “You're kidding?” I said to the pharmacist. “I'll have to skip this treatment and hope for the best.”
As often happened during my year-long cancer ordeal, I got lucky. “Oh, I'm sorry,” the pharmacist said. “I didn't mean to scare you. That's the actual price the computer spit out but you don't pay anything.” (Long story, not worth the effort here today.)
The chemotherapy finished in January but the price of the four prescription drugs I take now are, if nothing like that oral chemo treatment, scary enough while I've been in the donut hole - they've busted my small budget all to hell.
That's the thing about money, it's relative. If you've got enough, all good. If not, you could die.
Here's the story I really came here to tell you today.
Three or four weeks ago, I was next in line at the pharmacy to pick up a prescription and although I was behind the separator that gives customers privacy while talking with the pharmacist, I could clearly hear most of the conversation at the window.
The customer, older than I by a decade I guessed, did not have enough money to pay for her prescriptions. I overheard the phrase, “donut hole.”
There are some programs that can help certain low-income patients with payment but apparently none were available in this case and the two women – one a young-ish professional, the other knocking on frailty's door – were at an impasse, neither knowing what to do or say next.
Something came over me and without thinking it through, I marched up to the window, gave the pharmacist my credit card and said, “Use this.”
There were some “oh no, I couldn'ts” and “please don't mention its” between the older woman and me but we sorted it out and I was relieved to see – having realized by then what I might have gotten myself into - that at a couple of hundred dollars and change, it was nowhere near that oral chemo price.
This story is not to tell you how wonderful I am. There are plenty of people in the world who will tell you otherwise and they are not wrong. Not to mention the voice in my head that day yelling, “What are you doing, screwing up your budget that's already a mess from the price of your own drugs?”
But nowhere near as much a mess as that old woman's. Here's the real problem:
No one should go without health care of any kind – treatment or drugs – because they don't have enough money. No one.
Some small help for prescriptions drugs is due soon thanks to former President Obama's Affordable Care Act which included a provision, when it was enacted in 2010, to gradually close the donut hole by year 2020, now changed to 2019, although some healthcare experts suggest the insurance companies will increase premiums and/or deductibles when it happens.
That prediction is of a mindset with the many politicians who want to cut Medicare, Medicaid, and Social Security too. President Trump campaigned on a promise not to do that but if we didn't know before, we surely do now that you can't count on anything Trump says.
It would be a good thing for all Americans, as we make decisions about which candidates to vote for in the midterm election in November, to think about increasing moves toward universal healthcare or Medicare-for-all that are stirring in some enlightened political circles.
Would it be difficult to do? Yes. Would it take a long time to happen? Yes. Would it be expensive? Yes. Would our taxes go up? Yes. But the time has come, it is the right thing to do and we have a lot of examples to study and learn from: just about every western democracy already has such a system.
Excuse me now while I go worry about what will happen with that old woman next time she needs to fill her prescriptions and is still in the donut hole.