Shaken by Medicare

The President, at the State of the Union address, announced his plan to re structure America's health care system. Actually, he announced that he had a plan, but we thus far have heard virtually nothing about the plan itself.

But any and all of us should be very concerned in light of The Administration's recent overhaul of Medicare. Why? Because so far, those who have benefitted from the supposedly easier system have been scarce.

While those whose lives are thrown into more difficulty, confusion, and beaurocracy as a result of the changes has increased. Seniors can't get their medication. Low income families have to change doctors and pharmacists, and can't get theirs.

But there's another population shaken to the core by these changes:

A 43-year-old client of Knoll's mental health agency, a man who suffers from bipolar disorder, had come from his pharmacy frustrated to the point of meltdown. There were snags in his new Medicare drug plan. Of his four medicines, it would fill only two.

"I'm not going to take any of them anymore," he yelled, according to the report by caseworkers. Before they could do anything, he grabbed the prescription bottles he'd just gotten, ran for the restroom and dumped both in the toilet.

"He flushed everything he had on hand," recounted Knoll, executive director of Threshold Services in Silver Spring, whose staff spent day after day last month grappling with the many ramifications of the government's troubled program. Threshold came to the rescue of clients who couldn't get any medications or who, despite their pills, were in increasing distress because of all the confusion. It reimbursed several who'd mistakenly paid hundreds of dollars for pills that should have cost them a few dollars -- and replenished the supply of the client who had thrown his away.

"I'm not saying it's the federal government's fault he flushed his meds," Knoll said. "I'm saying it's the federal government's fault he couldn't get his meds. It's not surprising that people with mental illness respond in ways that people with mental illness respond."

Since the prescription program made its debut Jan. 1, some of the estimated 2 million mentally ill Americans covered because they receive both Medicare and Medicaid have gone without the drugs that keep their delusions, paranoia, anxieties or stress in check. Mental health service providers and advocacy organizations nationwide say they worry that scores are at high risk of relapse. Numerous people have been hospitalized.

"The continuation of medications is absolutely critical to keep them in community living," said Steven S. Sharfstein, chief executive of the Shepherd-Pratt Health System in Baltimore and president of the American Psychiatric Association. Last week, the association joined other mental health groups in a lengthy talk with Medicare officials about the myriad problems.

"I really don't know what the future will bring. . . . I have a very deep concern that psychiatric patients will suffer disproportionately," Sharfstein said. "If by the end of February or March, if [federal officials] haven't figured this out, we could have an epidemic on our hands."

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But repeatedly, she and others say, people have fallen through the program's cracks and discovered they have no insurance -- and have either run out of pills or rationed their medicine because they feared they would be left without.

Or they have been assigned to plans that will pay for some but not all of their psychiatric prescriptions -- an untenable and potentially dangerous situation given the complicated multiplicity of drugs people often take, with some pills to treat symptoms and others to counteract side effects. Unlike many medicines, psychiatric drugs are not easily substituted.

In Alexandria last month, a mother of two with a history of homelessness and attempted suicide left a drugstore empty-handed after being told her antidepressant was not covered. "For her, it was overwhelming," said Lix Wixson, director of acute care at the local Community Services Board. "She shut down."

Though Tom Cruise thinks the AntiCentenarian is being "glib," we actually think that those who can actually join society once again due to psychiatric medication deserve to- they have that right. It's a human right- it's humane. And it seems as though there have been systemic oversights time and time again with this Medicare restructuring, and those who have the most to lose from it... lose it all.