After spending two years living off his small pension and the US$700 monthly cheque from Social Security Administration without receiving an increase, Gordon, a Bajan retiree in Boston, at last had something to cheer him up when he heard that a small increase in Social Security would come his way in 2012.
Social Security – the American equivalent of Barbados’ National Insurance Scheme – is giving 59 million beneficiaries a cost-of-living adjustment of less than one per cent.
But herein lies the rub. Gordon, a recipient of Medicare Part D, a federal programme that subsidizes the costs of prescription drugs is unlikely to see much, if any of the increase. It’s going to pay for medication he needs for diabetes and hypertension.
So while his relatives in Barbados are getting their medication virtually free, co-payments and insurance costs for access to health care services in the United States are a fact of life across America.
Marsha Wardle-Rogers, a Bajan in Canada, summed it up well: “I would have to say that I think the way health care is set up in Barbados is better. Here in Canada you do not have the option to go private if you want to, and that means months of waiting to see a doctor.
Successive governments have provided free universal care and since the 1970s they had medication tacked onto it, long before Part D went into effect in the United States on January 1, 2006 through the Medicare Prescription, Improvement and Modernization Act of 2003. Barbados’ investment in its people’s health, especially the landmark introduction of the drug service more than 30 years ago has paid handsome dividends.
A major difference between Barbados and America is the issue of cost. The Barbados scheme is free, while in the United States there is a complicated tiered co-pay system.
Tier 1 might have a co-pay of US$5 to US$10 per prescription for generic drugs; Tier 2 which prefers brand-name drugs has a co-pay of $20 to $30; Tier 3, which may be reserved for non-preferred brand drugs, requires higher co-pay of between $40 and $100.
Tier 4 contains specialty drugs and they have the highest co-pay. Poor Part D beneficiaries are eligible for a low-income subsidy, which pays for all or part of the monthly premium, the annual deductible and drug-co-payments. But there is a crucial coverage limit of about $2, 830 and once it is reached, people must pay the full cost of prescription drugs up to total out-of-pocket expenses of $4,550 annually. This coverage gap, often called the “donut-hole” is to be gradually expanded under President Barack Obama’s health care.
Clearly, then, Bajans may not have access to the highly sophisticated medical care available in the United States and Canada, but they have a good thing going for them.