Mother comes to visit, but she doesn't want to live here.
There are many reasons for this: for instance, I sleep nights; she sleeps til afternoon, stays up
til dawn. I like to have Andrea Bocelli and Sarah Brightman in the background while I work;
Mother watches Jerry Springer and Oprah.
However, the real reason she won't move to Massachusetts from Pennsylvania is PACE, which
stands for Pharmaceutical Assistance Contract for the Elderly.
At age 84, she is mentally sharp and would be in good health were it not for the emphysema,
caused by almost 60 years of smoking until she quit cold-turkey a few years ago. Last month
she purchased seven prescriptions from her local pharmacy. The cost was $428.00; the bill
was $42.00. Mother and her senior friends pay $6.00 per prescription, for all drugs, no matter
how many they take.
PACE is funded primarily by the Pennsylvania lottery. Gamblers, God bless them, choose to
support a prescription drug program that makes a lot of income-eligible senior citizens very
happy.
The Massachusetts lottery funds local aid to the cities and towns. In fact, when our lottery
began, it was sold as the solution to our extraordinarily high property taxes; however, the
property taxes remained high anyhow until the voters passed Proposition 2« in 1980.
This is one of the things that has always interested me about my home state of Pennsylvania.
According to the Tax Foundation ranking for Fiscal Year '98, the latest year for which data is
available, Pennsylvania ranks 22nd in total government taxation per capita, compared to
Massachusetts ranking of fifth highest in the country. Relative to personal income, PA ranks
38th, compared to Massachusetts 23rd. The largely blue-collar population doesn't tolerate the
level of taxation that has long been accepted here.
Though Pennsylvania is much larger, it's population is just double ours; it spends, however,
only half again as much as we. Yet when I visit, I don't notice any missing essential services.
The roads, despite harsher winters, seem at least as good as ours; crime doesn't seem to be
out of control; the schools seem no worse than anywhere else in the national government-education
monopoly. Medicaid and other safety net programs are available. And, seniors get
their drugs for $6.00! Why can't Massachusetts have both lower taxes and prescription drug
assistance for senior citizens?
All I can figure is, Pennsylvania politicians have different priorities than ours. I think we should
solve the MA-PA comparison before we add to the coming Medicare crisis by adding
prescription drugs to the cost of that federal program, as some Washington politicians are
proposing.
The state Medicaid program is also having a problem with rising drug costs for the poor, and
among the ideas being proposed is a plan for group drug purchasing and another for price
controls. As the customer taking care of the poor, the state can certainly write contracts with
restrictions if it can find a willing provider. However, proposals that would spread that state
control into the private sector could be, literally, dangerous to our health.
Group purchasing is the concept behind the drug benefits in some health insurance packages,
so there's no reason that seniors shouldn't buy into a group purchasing plan through
organizations to which they belong. But anything that could discourage competition throughout
the pharmacy profession, like having the government choose a favored drug provider for large
parts of the population, is a bad idea. Some patients don't mind paying a little more to their
local drugstore for delivery services or the personal attention they get from their own
pharmacist, which has been known to save lives.
As for price controls, they've inevitably resulted in shortages in other areas of economic activity
where they have been tried. Our health is one area where we don't want to take a chance on a
product being unavailable because no one is willing to produce or sell it for the capped price.
In general, most government subsidies come with a guaranteed built-in cost increase for
everyone who doesn't get the subsidy and/or for the taxpayers. It's classic supply and demand:
the price will rise to meet the unlimited supply of money that the government gets by simply
demanding that we turn it over "or else."
Then anytime the government wants to waste money somewhere else, and taxpayers resist a
tax hike, heartless politicians will respond by threatening to cut off an essential service, in this
case our parents' medication. If some advocates have their way, the government will control
everyone's meds as part of a universal health care scheme.
A government monopoly -- now there's a plan. Our pharmacies will be as effective as our
schools. Better to trust our health to the gamblers, as my ma does in PA.