December 6, 2003 - The Devil, they say, is in the details. When the President signs the Medicare Reform Act of 2003 into law next Monday millions of older Americans will look forward to January 1, 2006 as the end of their ability to afford to fill the prescriptions that keep them alive. I am over 65 and still employed. I am diabetic and have coronary artery disease. I am a member of an HMO, the cost of which is paid by my employer. Even though I am not retired the rules of the HMO required that I enroll in Medicare on my 65 th birthday. Today I am covered by the HMO's prescription drug benefit. Each month when I fill the prescriptions for the medicines that keep my incurable diseases at bay, I pay $30 as my co-payment of the $600 monthly - $7200 annual - cost of the medicines that my doctors have prescribed to keep me alive. Under the bill I will lose that coverage.

When the big ball drops at Midnight to usher in 2006 the prescription drug benefit provided by my HMO will be illegal and disappear. At the stroke of midnight it will be illegal for me to buy insurance to fill the gap between the prescription coverage afforded by Medicare and the cost that the pharmaceutical industry imposes on me to stay alive. Barring price increases for the medicines I depend on my cost will increase from $360 per year to $3,725 per year to welcome in the New Year. That does not include the premium deducted from my Social Security check for the new "benefit" the Republicans so graciously gave me.

Why can't we buy coverage to fill in the gaps? Why can't the plans we are in continue to cover our prescriptions? Well, if we have coverage to fill in the gaps the Republicans fear we will "overuse" the coverage. The Conference Committee report that accompanied the bill justified the ban on insurance. "Numerous studies have demonstrated that covering deductibles and coinsurance has led to higher Medicare spending because beneficiaries become insensitive to costs," the report said. "Beneficiaries with Medigap consume $1,400 more in Medicare services than beneficiaries without supplemental coverage."

Now I can't speak for the rest of America but I am not enamored with the idea that my medical condition requires that I take pills to stay alive. Modern medical science has given me a choice - I can pop those pills daily or I can choose to die. If that is what the studies mean by "overusing" the system, then I suppose that I will continue to choose to take the pills and stick around a while - at least while I can cut my budget by eating less, shivering more in the winter, shopping at the Goodwill store for my clothes and making Mr. Ming share his food bowl. That is the Devil in these details.