This Is Your Congress. This Is Your Congress on Drugs.

As someone who for several years dealt with epilepsy and the medication (and side effects) attendant to that condition, I'm appalled to read that coverage under the new Medicare prescription drug dispensation restricts and excludes whole classes of antiepileptic drugs. Barbiturates, for example, are not covered at all, for seemingly arbitrary reasons—though I agree with one TPM reader that there's surely a Republican shibboleth at the root of that objection.

Perhaps some congressmen vaguely recalled "barbiturates" from the Just Say No! educational pamphlets that his children probably accepted as to-do lists for the weekend. Maybe, just as with the ink and the pork and the coveting the neighbor's ass, benzodiazepenes are namechecked in the Book of Leviticus; where there's legislation authored by the Republican leadership, there's fire—and brimstone. Or more insidiously, as the above-linked reader puts it, "maybe the competing drug classes are much more profitable for someone's campaign contributors (as both benzodiazepines and barbiturates are cheap and produced as generics, unlike their likely treatment alternatives)."

Whatever the reasoning and whatever your philosophical inclinations toward state health care, it must be acknowledged that there simply is no second-best alternative to some of these drugs. My experience was instructive. I experienced seizures belonging to a variety called tonic clonic, which sounds like a long-last Pavement album. After my first seizures, many of the antiepileptics I tried caused extremely severe side effects: in the worst cases, seizures, but also profuse nosebleeds and profound visual chromatic defects (dramatic "red-shifting" in everything I saw, as it were). Tonic-clonic seizures: not as fun as they sound. Tonic-clonic side effects: nearly as disappointing as the seizures.

My antiepileptic wasn't a barbiturate, but I was prescribed many before I found a medication with a profile of side effects I could live with. (I eventually weaned myself off antiepileptics and have lived fun and fancy free for two or three years now—although another seizure would mean that I'd have to return to the pills for good.)

But my profile did change over time, and it's conceivable that at some point I might have had to (and may still yet) need to explore other options or even take a cocktail of medications. Given that under the new dispensation, anticonvulsants old (mysoline) and new (lyrica)—along with whole categories of drugs (benzodiazepines, barbiturates)—are not covered by Medicare, appropriate prescriptions will only be an affordable option for those not well off if dual eligibility (state and federal aid) allows for the right intersection of drug coverages. Which is to say nothing about the process for determining the right intersection of drug coverages.

State Medicaid, federal Medicare, and temporary emergency relief, that is—of the likes declared by several states already in the wake of institutional confusion and exceptional incompetence seen in the rollout. The Citizen reports on just one of the many cases of the new January blues, in which an epileptic was greeted by the pharmacist with hundreds of dollars in copayments, no clear avenue for redressing her situation, and limited time to resolve the problem.

Again, the tragedy with specific respect to epilepsy is that there is no second-best alternative for many of the available drugs—but these are predictable problems that probably apply to a range of chronic conditions. I haven't followed the prescription drug benefit fallout as closely as your Ezra or your Lindsay; the most insightful thing I could say about the issue is that it's one helluva sedative. Feel free to take me to task for the angles I haven't appreciated here—I'm sure I'm just repeating the basic orthodox liberal points on the subject. But the complaints raised by the Epilepsy Foundation strike me as very obvious, the sort of broad, foundational considerations raised by the very prospect of revising state health care standards. How was Congress able to so deliberately fail to address these concerns?

It happens that I'm young, educated, not dependent on state aid, not infirm or unaware of events, and probably not even likely to have a seizure any time in the near future. But, of course, you don't write Medicare legislation with people like me in mind. Congress deliberately ignored and excluded those for whom the legislation matters most.

UPDATE: I forgot the scariest detail, which is what everyone wants to hear about, right? Skipping epilepsy medication not only exposes one to potential seizures, it can provoke a condition called status epilepticus: prolonged, clustered seizures that are not interrupted by periods of consciousness. High mortality rate and ominous as all hell. It's not untreatable, but one of the primary treatments is a procedure called rectal diazepam, which, if possible, involves an administration even less appealing than the name suggests. Status epilepticus, brrr.