Hard choices: Medicare Viagra

Between the narcissism of Baby Boomers and the naked greed of the drug manufacturers, the poor American taxpayer doesn't stand a chance. [It is so embarrassing sometimes to be a "boomer."]

Under a new Medicare prescription drug benefit law set to go into effect in January 2006, 41 million Medicare recipients will be covered for Viagra, Cialis and Levitra. Unless you've been hiding under a rock for a decade, you know what these drugs are used for. Aging men will correct their erectile shortcomings at the expense of the U.S. Treasury. If you will pardon the express, this might be the ultimate in "pork barrel" politics.

The New York Times explores the worry that the costs of the new program might overwhelm an already super-expensive new benefit, but it gives no estimates as to how much it will cost or whether the "enhancement benefit" might be responsible for the latest revisions in the projected cost of the Medicare program, expected to be somewhere near $720 billion over ten years. (When the government says $720 billion, that's the floor, not the ceiling.)

Fortunately, a few congressmen want to stop this latest nonsense before it starts:

"The thought of Medicare wasting vital resources on performance-enhancing drugs is unconscionable," said Representative Steve King, Republican of Iowa. "The focus should be on providing coverage for needy seniors."

Mr. King has introduced a bill that says Medicare cannot cover drugs "prescribed for the treatment of impotence."

Representative James P. Moran, Democrat of Virginia, a co-sponsor, said: "Here we are using money that could go to cancer, heart disease and other life-threatening illnesses and diverting it into the sex performance of men over 65. It's a scandal."

Naturally, spokespersons for the drug makers defend the program. Said Eli Lilly's Kindra Strupp:

"Erectile dysfunction is not a trivial thing for men who suffer from it. We've heard from thousands of men that it can interfere with their intimacy, erode their relationships with their partners, damage their self-esteem and lead to depression."

Well, yeah, getting old is a real bitch. Sorry to be blunt, but getting "too old to cut the mustard anymore" is part of the human condition. If any of these aging Boomers want Viagra at $9 or $10 a pill, let 'em pay for it out of their Social Security checks. Why should taxpayers fork over additional billions so that retirees can still get their jollies?

The truth is that the drug companies want a pipeline into the U.S. Treasury. That's called securing one's profit base. (Wonder if Ike would've warned against the Erectile-Pharmaceutical Complex if he'd only known?) Boomers want the buzz to continue indefinitely (so much for "Hope I die before I get old ..."). Liberals want to have a big pity-party for those men who are losing it to hardening-of-the-arteries, diabetes, hypertension, and no one wants to face the truth that these are contra-indicated conditions for taking such medications.

There are voices of sanity out there.

"These are essentially lifestyle drugs," said Daniel J. Callahan, co-founder of the Hastings Center, a bioethics research institute in Garrison, N.Y. "This is not a good way to spend a limited amount of money, at a time when other medical needs are greater. In many men, impotence is simply a function of age, though it may also be a result of disease."

And then there are those others:

Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania, said the issue had forced policy makers to ask, "What emphasis will we give to quality of life as a goal for pharmacological intervention?"

"Erectile dysfunction drugs don't save anybody's life, but make life more meaningful," Mr. Caplan said. "A fundamental principle of medical ethics is respect for the patient's right to self-determination. If you ask Medicare beneficiaries what they want, you will find that sexual function is high on the list. Many men would say that sexual dysfunction is just as important as loss of the ability to hear or to walk a mile."

He's probably right. But we'd bet these men are not yet deaf nor disabled.