Bedtime for Benzos

by Reihan Salam

There is a fascinating new story from ProPublica that tells us an awful lot about how government works.

Conservatives often rail against Medicare Part D, the Bush-era expansion of Medicare coverage that, among other things, helped finance prescription drugs for seniors. Yet when the program was first passed in 2003, Congress did put in a number of safeguards to contain spending. For one thing, Medicare was barred from financing a number of drugs that many state Medicaid programs excluded from coverage, including Valium, Xanax, Ativan, and other powerful prescription tranquilizers.

As it turns out, these tranquilizers are routinely abused, and they are particularly dangerous for older Americans, as they greatly increase the risk of serious falls and injuries. Given that Medicare pays when beneficiaries hurt themselves as a result of their reliance on these benzodiazepines (or “benzos,” as they’re also known), this strikes me as a perfectly reasonable stance to take. Of course, ProPublica reporters Charles Ornstein and Ryann Grochowski Jones suggest that there was no grand design behind this decision. Indeed, one of their interviewees, Andrew Sperling, head of federal legislative advocacy for the National Alliance on Mental Illness, believes that the decision to exclude benzos from coverage was a drafting error. That sounds about right. Can you imagine Congress deliberately protecting taxpayers from paying for prescription drugs that are very likely to harm their users?

We might not like federal meddling when it comes to the drugs we take, but of course Medicare wasn’t preventing doctors from writing prescriptions for benzos or patients from buying and taking them, provided they did so with their own money. Rather, the law simply held that if you were going to take benzos, well, you had to pay for them yourself.

But this accidental bout of sanity has come to an end. ProPublica reports that Congress eventually reversed its position, and 2013 was the first year in which Medicare Part D covered benzos. And in that one year alone, Medicare paid for 40 million prescriptions, at a cost of over $377 million. However, very few of these prescriptions were actually new prescriptions. Because benzos are relatively cheap (the most popular of them have been available in generic form for years), patients were quite happy to pay for them out of pocket. So the only thing that’s changed is that the federal government is now paying for these drugs. To be sure, there are seniors who can now use the money they might have otherwise spent on benzos on something else, and an extra $120 isn’t anything to scoff at for someone on a fixed income. It’s just not that clear that the federal government should be spending $120 per benzo user on paying for benzos rather than, say, some other intervention that might make them less likely to fall and injure themselves. Or could it be that we as a country are perfectly happy to medicate older Americans to death?

Part of me thinks that we shouldn’t blame Congress for this imbroglio. It was inevitable that medical providers, patients, and pharmaceutical companies would press for the federal government to pick up the tab for benzos. And besides, benzos are just a small part of America’s larger painkiller epidemic.​The deeper problem, I suspect, is that there are so many older Americans who are painfully isolated, which makes drugs that dull their pain very attractive. 

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