Long history of missed opportunities plague Medicare prescription drug benefit

Researchers from the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco, have completed a new historical analysis of the 38-year struggle to provide a prescription drug benefit to seniors as part of Medicare.

The report chronicles the series of missed opportunities, financial constraints and political divides that delayed the benefit for years, as well as the unusual circumstances that ultimately resulted in the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

The report is published in the current issue of the peer-reviewed journal, Milbank Quarterly.

Since its establishment in 1965, Medicare has provided health care to tens of millions of Americans aged 65 and older. According to the researchers, an outpatient prescription drug benefit was dropped from the original legislation, because some lawmakers thought that future costs for prescription drugs were too unpredictable and potentially costly.

The study's authors noted that prescription drugs actually accounted for nearly the same proportion of national health spending in 1965 as they do today.

"When we looked back historically, the need for a prescription drug benefit has always been there," said Thomas Oliver, PhD, lead author of the study and an associate professor in the Department of Health Policy and Management at the Bloomberg School of Public Health.

Over the decades however, lawmakers focused most of their attention on the even higher and more explosive costs of hospital services.

For their analysis, Dr. Oliver and his colleagues researched hundreds of journal articles and news accounts related to Medicare and prescription drug benefits. The researchers identified several important patterns, which factored into the policymaking decisions.

First, prescription drug benefits were seldom considered on their own merits and instead were usually tied to broader proposals

Contact: Tim Parsons
Johns Hopkins University Bloomberg School of Public Health

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