By Mary Landers
For Coastal Senior

Old people take lots of prescription drugs. Medicare doesn't pay for them.

That's the simple problem at the heart of a complex debate.

For Geraldine Haupt of Isle of Hope, prescription drugs mean the ability to live independently despite having a history of seizures and a stroke.

But the $1,185 monthly cost of her drugs outstrips her $795 monthly income.

"She was charging her medications," said her daughter-in-law Shirley Haupt, who lives nearby. "Her card got up to about a $6,000 or $7,000 balance."

The 77-year-old was resigned to do without until her daughter-in-law got her hooked up with Medbank, a local program that taps into pharmaceutical companies' giveaway programs.

The family had no other options.

"I don't know anybody who could pay that," Shirley Haupt said.

Medicare began 35 years ago to provide health care for all the elderly. At the time, not getting prescription drug coverage wasn't a big deal. In the 1960s relatively few drugs could do much to manage diseases of the elderly such as high blood pressure, arthritis and high cholesterol. Now drugs are at the forefront of such treatment.

Most younger Americans who have health insurance get prescription drug coverage with it. But about one-third of older Americans pay for drugs entirely out of their pockets.

So the scientific boon of pharmaceuticals is a monetary bust to them.

On average, $1,260 covers a Medicare recipient's drug needs for the year, according to Patricia Neuman, vice president and director of Medicare Policy Project at the Henry J. Kaiser Family Foundation in Washington, D.C. But 22 percent of seniors require less than $250 worth of drugs. Those healthy seniors bring the average spending down. At the other end of the spectrum, 7 percent of seniors need more than $4,000 worth of drugs a year.

Enough seniors feel squeezed by their prescription spending to bring four major reform proposals to Congress and to make Medicare prescription plans part of every presidential candidate's platform.

So it's almost inevitable that some seniors will get some government-sponsored or subsidized drug coverage in the future. Which seniors will get the coverage, how much they'll get, and when they'll get it are the questions for the next president and Congress.

The Bush and Gore plans differ in three main ways: overall spending, the degree to which they involve the private sector, and how well benefits are spelled out.

Based on its campaign estimates, the Bush plan would spend $110 billion over 10 years to reform Medicare and provide a prescription drug plan. Gore's plan would spend more than twice as much - $338 billion, according to the Congressional Budget Office - in the same time period just to add the prescription drug benefit.

Bush's plan relies heavily on participation from private insurers.

That issue is especially troubling to some policy analysts because insurers have been bailing out of Medicare HMOs.

"It's the kind of question where there may be a disconnect between a philosophical preference and a practical reality," Neuman said. "There's no requirement that private insurers contract with Medicare and stick with it."

Close to a million Medicare HMO recipients will lose that coverage this year, according to Libby Overly, a grass-roots manager with the National Committee to Preserve Social Security and Medicare, a Washington, D.C.-based advocacy group.

Gore's plan makes a prescription benefit part of Medicare, administered by the government.

Because it doesn't rely on the private insurers to develop benefits packages, Gore's plan is more detailed.

In Gore's plan, the premium would cost recipients about $25 per month or $300 per year. The government would kick in another $25. (The estimate jumps to $50 per month in 2008.)

That suggests near-universal coverage to Neuman.

Bush's plan offers to pay 25 percent of the average premium. But it's uncertain what companies will charge for the premium. Even the Bush campaign doesn't have estimates, according to Ray Sullivan, a spokesman.

Independent analysts guess the premiums will be higher than Gore's $25 mark. For one thing, the government would be putting less in the pot.

"We don't know what the premiums would be under Bush," Neuman said. "We have to go under what we know - the subsidies would be lower so the presumption is the premium would be higher," Neuman said.

Also, private insurers would be hard-pressed to meet Medicare's 2 percent administrative overhead, Overly said. Administrative costs for Medicare HMOs runs at about 14 percent, she said.

Gore's plan is more specific about coverage, too. It pays half of the first $2,000 in drug costs. The details in Bush's plan would vary depending on what insurance companies offered.

"The Bush plan could have as many plans as it has insurance companies participating," Overly said.

Both plans have provisions for catastrophic spending, though they define it differently. Gore's plan takes over responsibilities for costs after a patient spends $4,000 for drugs in a year and Bush's takes over $6,000.

Both plans also offer special consideration to seniors living on less than $11,000 per year. That gives additional help to about 44 percent of the seniors who have no drug coverage now.

When all this would happen remains to be seen. Once elected, the president has to work with Congress to pass the reform.

Even Bush's "immediate helping hand" provision - which provides block grants to states to help low-income seniors with prescriptions - has to pass Congress. Then states would have to grapple with it.

"States that don't have anything like that could take several years to set it up," Overly said.

Meanwhile seniors keep making trips to the drug store and hoping for relief.

"It takes a big part of our money," said Ann Atkinson, an Ardsley Park resident who pays about $340 a month for seven medications. "I think it'd be real nice if they could pay a good part of it."

Health reporter Mary Landers can be reached at landers@savannahnow.com or 652-0337.