Medicare: A Bush Disaster That My Life Depends on

I began needing drugs to stay alive one day in the early 1990s, though I did not realize it at the time. I was still a decade away from officially becoming an old person by US government standards, although I'd already started getting my mailings from AARP. I had spent the afternoon in the Plaza Hotel bar in New York City, meeting with an actor who'd said he wanted to make a film from a book I'd written. (To no one's surprise, it never happened.) I'd had a few bourbons without eating anything, and afterward I stopped off at a falafel place. Then I began to vomit blood.

I went to the doctor. He gave me the first of what was to become a series of yearly tests, snaking a fiber-optic device down my throat to look at my upper digestive tract. He announced that I had Barrett's syndrome, a dangerous precancerous condition in the cells of the lower esophagus, caused by years of acid reflux. But fortunately for me, the doctor said, there was a pill, still relatively new at the time, that could save me from a terrible fate -- a little purple pill. With that, I became one of the millions of people who take Prilosec and a crop of other prescription drugs for acid reflux, stomach ulcers, and heartburn.

This was when I learned what it means to get old. You're no longer like the average young person, who needs a course of antibiotics to cure a sinus infection, or painkillers for a sprained ankle. You have more in common with people who have life-threatening diseases like aids or cancer: Your access to the drugs you need may determine whether you will live another day, or another 10 years. Or it may determine whether you can see, or whether you can walk across a room. You will take pills until you die.

With that in mind, the question of what the government does to ensure America's elders get their drugs takes on a significance of Darwinian proportions. And so, it was with more than professional interest that I followed President Bush's push for a Medicare prescription drug plan in 2003 -- his signature health care initiative, and to date his only successful one. Congress passed the plan in a dramatic, clock-stopping session that November amid much media fanfare; two years later, I got a chance to try it out when I joined the 25 million people receiving benefits under what's now known as Medicare Part D.

Part D offers a disturbing window on the future of health care. For conservatives, it represents the sharp end of the stake they hope to drive into Medicare at large, destroying the largest and best single-payer health care program this nation has ever known. For progressives, it demonstrates the vast shortcomings of any health program -- no matter how "universal" -- that fails to defy Big Pharma and the insurance companies. For myself, perhaps the key lesson from dealing with Part D has been that the new plan doesn't have that much to do with ensuring drug access for seniors, but a great deal with securing the vested interests of the stakeholders -- from the Bush administration and the pharma industry, all the way to groups like aarp.

prilosec was just the beginning of my life in pills. A few years after my esophageal cancer scare, a doctor encouraged me to consider antidepressants, and I grudgingly went to see the psychiatrist he recommended. A genial, heavyset man, he greeted me from a leather armchair that was tilted back into a reclining position so he could comfortably view his patient. Then he launched into a series of rapid-fire questions: Do you have trouble sleeping? Wake up feeling blue? Think bad thoughts during the day? Ever think of committing suicide? At the end of the interrogation he smiled broadly and said, "You've got 7 out of 10." Turning on the electric motor in his chair, he winched himself upright and opened the door to a cupboard, revealing shelf after shelf of pill samples. He pulled out a package and said, "Here, see how this works."