Sunday, January 29, 2006
A bandaid for a hemorrhage
We all know Medicare Part D is an absolute mess and a terribly designed bill. But legislators are coming up with impotent (and totally uninventive) ways of fixing it:
Olympia Snowe said she will continue to push for a bill (S 2168) that would extend from May 15 to Dec. 31 the deadline for beneficiaries to enroll in the drug benefit without paying a penalty. According to AP/Long Island Newsday, at least 140 lawmakers -- most of whom are Democrats -- support various bills that would extend the enrollment deadline.
In the House, 10 bipartisan co-sponsors support a bill that would extend the enrollment deadline to June 30, 2007. A second House bill, which has 131 co-sponsors, would extend the deadline to Dec. 31 and allow beneficiaries to change plans once during the year.Seniors don't need more time (past the May 15th deadline). Nor do they need more information. None of these bills -- especially one extending the date way into 2007 -- will do a thing, because the problem is the bill itself. And not that it's just too complicated (although that's a major issue) -- it's just not a benefit that a lot of seniors deem worth paying for. Premiums are expensive, as are out of pocket costs. There's a huge donut hole in the middle, and there's no guarantee their drugs will be covered.
So while it's all well and good that legislators are trying to help, someone needs to send them a memo that extending deadlines won't fix anything.
Olympia Snowe said she will continue to push for a bill (S 2168) that would extend from May 15 to Dec. 31 the deadline for beneficiaries to enroll in the drug benefit without paying a penalty. According to AP/Long Island Newsday, at least 140 lawmakers -- most of whom are Democrats -- support various bills that would extend the enrollment deadline.
In the House, 10 bipartisan co-sponsors support a bill that would extend the enrollment deadline to June 30, 2007. A second House bill, which has 131 co-sponsors, would extend the deadline to Dec. 31 and allow beneficiaries to change plans once during the year.Seniors don't need more time (past the May 15th deadline). Nor do they need more information. None of these bills -- especially one extending the date way into 2007 -- will do a thing, because the problem is the bill itself. And not that it's just too complicated (although that's a major issue) -- it's just not a benefit that a lot of seniors deem worth paying for. Premiums are expensive, as are out of pocket costs. There's a huge donut hole in the middle, and there's no guarantee their drugs will be covered.
So while it's all well and good that legislators are trying to help, someone needs to send them a memo that extending deadlines won't fix anything.
Seniors ignoring Part D
A new poll indicates that more than half (53%) of seniors have no plans to enroll in a prescription drug plan. Less than a quarter (24%) have chosen a plan so far, and another quarter (23%) plan on enrolling but haven't done so. These poll results are consistent with findings from six months ago, a troubling sign for the Bush administration that in spite of additional information, seniors still do not want to participate in the new benefit.
There's good reason to trust this new poll, as it's fairly consistent with the number of seniors who've signed up thus far, especially if you adjust for seniors who are incapacitated or in nursing homes and not included in the sample. Health and Human Services (HHS) needs 15 million more people to sign up to meet its enrollment goal. Using the poll, if we expect 23% more seniors to enroll, another 8.1 million should do so by the end of the year. That leaves HHS almost 7 million short of its enrollment goal.
* had substantially higher incomes
* had higher education levels
* were more likely to be married, and
* did not differ in age from those already enrolled or likely to do so.
There's good reason to trust this new poll, as it's fairly consistent with the number of seniors who've signed up thus far, especially if you adjust for seniors who are incapacitated or in nursing homes and not included in the sample. Health and Human Services (HHS) needs 15 million more people to sign up to meet its enrollment goal. Using the poll, if we expect 23% more seniors to enroll, another 8.1 million should do so by the end of the year. That leaves HHS almost 7 million short of its enrollment goal.
The poll also collected data on respondents who did not plan on signing up for Medicare Part D. In general, they:
* w
ere among the lowest users of medical services* had substantially higher incomes
* had higher education levels
* were more likely to be married, and
* did not differ in age from those already enrolled or likely to do so.
These findings aren't surprising in the least; they're just a stark illustration that legislators have failed to convince those unlikely to need a prescription benefit to pay for it anyway. For these individuals, a 1% penalty per month is an insufficient incentive.
The poll also found that education efforts conducted between September and January were fairly effective. While only 11% of seniors in September and 8% in June were "very familiar" with Part D, that number increased to one quarter in December. Seniors are more able to correctly answer questions on the details of the bill, with 68% percent of seniors answering at least five of six questions correctly in December, compared to only 23% in September.
It's fairly troublesome that education efforts haven't increased the number of seniors planning to enroll. To convince that other 53% that it's in their best interest to sign up, some part of the bill will have to be altered. There's a number of fixes that might work, but one thing's for sure: further educational pushes will only be a waste of time.Wednesday, January 25, 2006
Medicare Part D by the numbers
Kaiser has released their report examining the number of beneficiaries enrolled so far in Medicare Part D.
Health and Human Services (HHS) has set a goal of 29.3 million enrollees in 2006. As of January 13, 14.3 million beneficiaries have enrolled in Medicare Part D plans. At first glance, that number appears to be 50% of the goal, so things must be on schedule, right?
Wrong. Dual eligibles, or people enrolled in both Medicare and Medicaid, were automatically assigned to a plan. As there are 6.2 million dual eligibles, that automatically enrolled number is almost half of everyone that's signed up thus far. And, it's important to note, those dual eligibles were already getting their medications through Medicaid.
Then there are the Medicare Advantage enrollees. Medicare Advantage acts as HMO-style coverage for Medicare, and with the passage of Part D, many of these Advantage plans added drug coverage. The process for signing up for a Medicare Advantage Part D plan is much simpler than choosing from the larger pool of Part D plans. So far, 4.5 million Medicare Advantage enrollees have signed up.
That leaves only 3.6 million people (out of the 14.3 cited by HHS) who have signed up for stand-alone Medicare Part D plans. Only 25% of those enrolled so far went through the debacle-style enrollment process .
HHS needs an additional 15 million beneficiaries to enroll by the end of the year to meet its goal. With all the dual eligibles (read: automatic) already signed up, that 15 million must comprise only Medicare Advantage and standard Medicare enrollees. In 2005 only 12% of Medicare enrollees had Medicare Advantage Plans. That means the vast majority of the 15 million people who still need to sign up in 2006 will have to go through stand-alone Medicare Part D Plans.
To meet HHS' goal, more than 10 million will have to overcome the "choice," confusion and frustration to participate in the drug benefit. The program needs these people to sign up to ensure its long-term viability and to keep premiums from soaring. So, while states have come to rescue providing temporary coverage and reimbursement, there's been no fix to make it easier for 15 million more people to sign up. There's still room for an ingenious lawmaker to come up with that.
Health and Human Services (HHS) has set a goal of 29.3 million enrollees in 2006. As of January 13, 14.3 million beneficiaries have enrolled in Medicare Part D plans. At first glance, that number appears to be 50% of the goal, so things must be on schedule, right?
Wrong. Dual eligibles, or people enrolled in both Medicare and Medicaid, were automatically assigned to a plan. As there are 6.2 million dual eligibles, that automatically enrolled number is almost half of everyone that's signed up thus far. And, it's important to note, those dual eligibles were already getting their medications through Medicaid.
Then there are the Medicare Advantage enrollees. Medicare Advantage acts as HMO-style coverage for Medicare, and with the passage of Part D, many of these Advantage plans added drug coverage. The process for signing up for a Medicare Advantage Part D plan is much simpler than choosing from the larger pool of Part D plans. So far, 4.5 million Medicare Advantage enrollees have signed up.
That leaves only 3.6 million people (out of the 14.3 cited by HHS) who have signed up for stand-alone Medicare Part D plans. Only 25% of those enrolled so far went through the debacle-style enrollment process .
HHS needs an additional 15 million beneficiaries to enroll by the end of the year to meet its goal. With all the dual eligibles (read: automatic) already signed up, that 15 million must comprise only Medicare Advantage and standard Medicare enrollees. In 2005 only 12% of Medicare enrollees had Medicare Advantage Plans. That means the vast majority of the 15 million people who still need to sign up in 2006 will have to go through stand-alone Medicare Part D Plans.
To meet HHS' goal, more than 10 million will have to overcome the "choice," confusion and frustration to participate in the drug benefit. The program needs these people to sign up to ensure its long-term viability and to keep premiums from soaring. So, while states have come to rescue providing temporary coverage and reimbursement, there's been no fix to make it easier for 15 million more people to sign up. There's still room for an ingenious lawmaker to come up with that.
Federal (Medicare) corruption watch
Just what do you make of this news report?
House and Senate GOP negotiators, meeting behind closed doors last month to complete a major budget-cutting bill, agreed on a change to Senate-passed Medicare legislation that would save the health insurance industry $22 billion over the next decade, according to the nonpartisan Congressional Budget Office.
The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.
The change in the Medicare provision underscores a practice that growing numbers of lawmakers from both parties want addressed. More than ever, Republican congressional lawmakers and leaders are making vital decisions, involving far-reaching policies and billions of dollars, without the public -- or even congressional Democrats -- present.
The corruption scandal involving Republican former lobbyist Jack Abramoff and the bribery plea of former congressman Randy "Duke" Cunningham (R-Calif.) have prompted calls for a restructuring of lobbying rules and congressional practices that make lobbying easier.
Maybe one day, when the slime is scraped off, home care will get a fair hearing in Washington DC. I'm a dreamer, I know.
House and Senate GOP negotiators, meeting behind closed doors last month to complete a major budget-cutting bill, agreed on a change to Senate-passed Medicare legislation that would save the health insurance industry $22 billion over the next decade, according to the nonpartisan Congressional Budget Office.
The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.
The change in the Medicare provision underscores a practice that growing numbers of lawmakers from both parties want addressed. More than ever, Republican congressional lawmakers and leaders are making vital decisions, involving far-reaching policies and billions of dollars, without the public -- or even congressional Democrats -- present.
The corruption scandal involving Republican former lobbyist Jack Abramoff and the bribery plea of former congressman Randy "Duke" Cunningham (R-Calif.) have prompted calls for a restructuring of lobbying rules and congressional practices that make lobbying easier.
Maybe one day, when the slime is scraped off, home care will get a fair hearing in Washington DC. I'm a dreamer, I know.
State corruption watch
Even as top lawmakers are being convicted of corruption, the criminal investigations of the way the public's business continues to be conducted at the Capitol are intensifying. The latest sign is news of a federal grand jury investigation into a controversial state travel contract. Bringing to justice the ringleaders of the so-called caucus scandal, while important, will not put an end to Wisconsin's political corruption problem, because the problem is not a handful of politicians who lost their way, it's a system that is rotten to the core. Until this system that forces politicians to take out a second mortgage on their souls to run competitively for public office is changed, we'll continue to have more investigations, indictments and convictions.
Another twist on tort "reform"
Patients sometimes file malpractice suits simply to obtain information about their own treatment. They do this because hospitals routinely refuse to disclose information about their quality of care unless they are taken to court.
Check this out: Claudia Mejia gave birth eight and a half months ago....Twelve days after giving birth at Orlando Regional South Seminole hospital, she was transported to Orlando Regional Medical Center where she became a quadruple amputee. Now she can not care for or hold her baby.
"Yeah, I want to pick him up. He wants me to pick him up. I can't. I want to, but I can't," she said. "Woke up from surgery and I had no arms and no legs. No one told me anything. My arms and legs were just gone."
Her attorney, Judy Hyman wrote ORHS a letter saying, according to the Florida statute, "The Patients Right To Know About Adverse Medical Incidents Act," the hospital must give her the records....The hospital's lawyers wrote back, "Ms. Mejia's request may require legal resolution." In other words, according to their interpretation of the law, Mejia has to sue them to get information about herself.
Don't get me wrong. I don't think the doctors at Orlando Regional Medical Center just hacked off Mejia's arms and legs for no reason. She had contracted both a flesh eating bacteria and toxic shock syndrome, and amputation might very well have been the only option.
Still, if I woke up from surgery with no arms or legs, I'd want to know every last detail about what happened to me. Why should I have to file a lawsuit to get that?
Check this out: Claudia Mejia gave birth eight and a half months ago....Twelve days after giving birth at Orlando Regional South Seminole hospital, she was transported to Orlando Regional Medical Center where she became a quadruple amputee. Now she can not care for or hold her baby.
"Yeah, I want to pick him up. He wants me to pick him up. I can't. I want to, but I can't," she said. "Woke up from surgery and I had no arms and no legs. No one told me anything. My arms and legs were just gone."
Her attorney, Judy Hyman wrote ORHS a letter saying, according to the Florida statute, "The Patients Right To Know About Adverse Medical Incidents Act," the hospital must give her the records....The hospital's lawyers wrote back, "Ms. Mejia's request may require legal resolution." In other words, according to their interpretation of the law, Mejia has to sue them to get information about herself.
Don't get me wrong. I don't think the doctors at Orlando Regional Medical Center just hacked off Mejia's arms and legs for no reason. She had contracted both a flesh eating bacteria and toxic shock syndrome, and amputation might very well have been the only option.
Still, if I woke up from surgery with no arms or legs, I'd want to know every last detail about what happened to me. Why should I have to file a lawsuit to get that?
State of the Union: Health care
Not to belabor the obvious, but: The American health care system is broken.
Skyrocketing costs have placed enormous burdens on families and small businesses. The United States spends approximately $1.7 trillion -- more than 15% of the nation's economy -- on health care, yet the nation still falls behind on basic health care measures. "Health care costs are seen as the primary threat facing our country's economy," and the Bush administration has only made the situation worse. During President Bush's term, "the number of Americans without health insurance has increased by 6.2 million," now totaling nearly 46 million. Most damning, in my mind, is the fact that 11.2% of all children in this country—8.3 million—lack even basic health insurance.
The American health care system needs fundamental reform to be fixed -- "reform that provides affordable coverage to all Americans, controls costs and makes prevention a national priority."
In his 2004 State of the Union address, Bush promised to "extend the benefits of modern medicine throughout our country." But he has not kept his promise; the "number of Americans without health insurance rose by 800,000 last year, reaching a record high of nearly 46 million." The number of uninsured Americans now exceeds "the cumulative population of 24 states plus the District of Columbia." Unless the nation drastically changes course, approximately 52 million are expected to be uninsured for the entire year in 2010.
The #1 reason people are uninsured is because health care coverage is too expensive. Medical bills account for half of all personal bankruptcies. Health insurance premiums for workers have increased by 73%, while wages have grown by only 15% and inflation by 14%.
Bush's 2004 State of the Union promise to work with Congress to "control those [health care] costs" has run hollow. Between 2001 and 2003, national spending for prescription drugs increased by 14%. Employees are increasingly being left to find coverage on their own; nearly half of all small businesses no longer provide health coverage for their workers. Employee contributions for health care have increased 126% over the last 5 years, compared to a 76% increase for employers.
America spends 2.5 times more per capita than the average of other wealthy nations on health care -- which provide health care to all their citizens -- yet the nation still ranks 34th in life expectancy, 41st in infant mortality, and 37th in overall health system performance. Total national health expenditures increased by 7.7 % in 2003 over 2002, "four times the rate of inflation in 2003." Despite high spending and technological advances, "Americans have lower odds of surviving colorectal cancer and childhood leukemia than Canadians," and the confusing American health care system has resulted in "30% of adults in the U.S. -- more than the rate in comparable nations -- have problems with coordination of care."
Racial, ethnic, and socioeconomic disparities still pervade America's health care system. Nationwide, black Americans continue to have higher death rates from chronic diseases than any other U.S. racial or ethnic group. The infant mortality rate for black Americans is twice the rate for whites and the life expectancy for black American males is 7 years less than for white males. Among "Medicare beneficiaries, white patients were more likely to receive high-cost procedures than black patients, and the disparity had increased, in some cases and places, between 1992 and 2001." People with lower incomes continue to have worse health. A failure to address these problems "will inevitably keep us in the lesser ranks of nations in terms of health and health care."
The Bush administration's "consumer-driven health care" plans -- health savings accounts -- are doing more harm than good by shifting costs from the healthy to the sick and allowing prices to rise unchecked. "'Consumer-driven' is a nice slogan, but it turns out buying health care isn't at all like buying clothing," said New York Times columnist Paul Krugman. The Bush administration's implementation of its new Medicare prescription drug plan has been an "unmitigated disaster" and Gov. Tim Pawlenty (R-MN) said, "The new federal program is too complicated for many people to understand, and the implementation of the new program by the federal government has been awful."
The Bush administration's policies have been friendly to one group at least: While many Americans cannot afford coverage at all, drug companies made more profits in 2002 than the other 490 companies in the Fortune 500 combined.
Skyrocketing costs have placed enormous burdens on families and small businesses. The United States spends approximately $1.7 trillion -- more than 15% of the nation's economy -- on health care, yet the nation still falls behind on basic health care measures. "Health care costs are seen as the primary threat facing our country's economy," and the Bush administration has only made the situation worse. During President Bush's term, "the number of Americans without health insurance has increased by 6.2 million," now totaling nearly 46 million. Most damning, in my mind, is the fact that 11.2% of all children in this country—8.3 million—lack even basic health insurance.
The American health care system needs fundamental reform to be fixed -- "reform that provides affordable coverage to all Americans, controls costs and makes prevention a national priority."
In his 2004 State of the Union address, Bush promised to "extend the benefits of modern medicine throughout our country." But he has not kept his promise; the "number of Americans without health insurance rose by 800,000 last year, reaching a record high of nearly 46 million." The number of uninsured Americans now exceeds "the cumulative population of 24 states plus the District of Columbia." Unless the nation drastically changes course, approximately 52 million are expected to be uninsured for the entire year in 2010.
The #1 reason people are uninsured is because health care coverage is too expensive. Medical bills account for half of all personal bankruptcies. Health insurance premiums for workers have increased by 73%, while wages have grown by only 15% and inflation by 14%.
Bush's 2004 State of the Union promise to work with Congress to "control those [health care] costs" has run hollow. Between 2001 and 2003, national spending for prescription drugs increased by 14%. Employees are increasingly being left to find coverage on their own; nearly half of all small businesses no longer provide health coverage for their workers. Employee contributions for health care have increased 126% over the last 5 years, compared to a 76% increase for employers.
America spends 2.5 times more per capita than the average of other wealthy nations on health care -- which provide health care to all their citizens -- yet the nation still ranks 34th in life expectancy, 41st in infant mortality, and 37th in overall health system performance. Total national health expenditures increased by 7.7 % in 2003 over 2002, "four times the rate of inflation in 2003." Despite high spending and technological advances, "Americans have lower odds of surviving colorectal cancer and childhood leukemia than Canadians," and the confusing American health care system has resulted in "30% of adults in the U.S. -- more than the rate in comparable nations -- have problems with coordination of care."
Racial, ethnic, and socioeconomic disparities still pervade America's health care system. Nationwide, black Americans continue to have higher death rates from chronic diseases than any other U.S. racial or ethnic group. The infant mortality rate for black Americans is twice the rate for whites and the life expectancy for black American males is 7 years less than for white males. Among "Medicare beneficiaries, white patients were more likely to receive high-cost procedures than black patients, and the disparity had increased, in some cases and places, between 1992 and 2001." People with lower incomes continue to have worse health. A failure to address these problems "will inevitably keep us in the lesser ranks of nations in terms of health and health care."
The Bush administration's "consumer-driven health care" plans -- health savings accounts -- are doing more harm than good by shifting costs from the healthy to the sick and allowing prices to rise unchecked. "'Consumer-driven' is a nice slogan, but it turns out buying health care isn't at all like buying clothing," said New York Times columnist Paul Krugman. The Bush administration's implementation of its new Medicare prescription drug plan has been an "unmitigated disaster" and Gov. Tim Pawlenty (R-MN) said, "The new federal program is too complicated for many people to understand, and the implementation of the new program by the federal government has been awful."
The Bush administration's policies have been friendly to one group at least: While many Americans cannot afford coverage at all, drug companies made more profits in 2002 than the other 490 companies in the Fortune 500 combined.
Fixing Part "D"isaster with propaganda
Bush's new Medicare drug prescription plan is causing growing unease among seniors - according to Reuters, "tens of thousands of people were unable to get medicines promised by Medicare," since the new program began, and not only that, but, "several states declared public health emergencies, and many states announced that they would step in to pay for prescriptions that should have been covered."
So how is the Bush administration going to fix its dreadful Medicare plan? Why, it's nothing a good strong dose of propaganda can't fix!
It turns out that the administration is spending taxpayer cash to send its health advisers on a nationwide tour to prop up flagging support for the plan. After all the good work George W. Bush did promoting his plans to reform Social Security last year, I'm sure this latest tour will be a smashing success.
Oh, and by the way - those states, including Wisconsin, that paid for prescriptions that should have been covered by Medicare? The federal government isn't going to reimburse them. Apparently they've got plenty of money to spend on pumping up the new Medicare plan, but no money to actually fund it. Sounds about par for the course.
Good news update: The Bush administration has "agreed to help repay states that stepped in to buy prescription drugs for poor seniors whose coverage failed under the beleaguered Medicare prescription drug benefit."
So how is the Bush administration going to fix its dreadful Medicare plan? Why, it's nothing a good strong dose of propaganda can't fix!
It turns out that the administration is spending taxpayer cash to send its health advisers on a nationwide tour to prop up flagging support for the plan. After all the good work George W. Bush did promoting his plans to reform Social Security last year, I'm sure this latest tour will be a smashing success.
Oh, and by the way - those states, including Wisconsin, that paid for prescriptions that should have been covered by Medicare? The federal government isn't going to reimburse them. Apparently they've got plenty of money to spend on pumping up the new Medicare plan, but no money to actually fund it. Sounds about par for the course.
Good news update: The Bush administration has "agreed to help repay states that stepped in to buy prescription drugs for poor seniors whose coverage failed under the beleaguered Medicare prescription drug benefit."
Medicare, HMOs, the GOP and secret government
The conventional wisdom about the Medicare prescription drug bill is that it was a huge giveaway to the pharmaceutical industry. And it was. But the real payoff was to the insurance industry, one of the Republican Party's favorite special interest groups.
Yesterday, the Congressional Budget Office reported on the latest valentine from the GOP to the insurance industry. It turns out that Republicans met in closed session last month to make technical changes to a budget cutting bill that saved the industry $22 billion:
The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.
...."It happens in the dead of night when lobbyists get a [Republican lawmaker] in the corner and say, 'We've got to have this,' " said Rep. Fortney "Pete" Stark (Calif.), the Democrats' point man on Medicare issues. "It's a pattern that just goes on and on, and at some point the public's going to rise up."
[Senate Finance Committee Chairman Charles] Grassley disputed the CBO's interpretation of the change as "ridiculous," dismissing what appears to be a major insurance industry victory as merely a mistake in CBO calculations, not a substantive policy change. He said he accepted the policy change because he "didn't see a big difference from the Senate position and the conference position."
Indeed. Not a "big difference." Then why did the insurance industry lobby so desperately to get it passed?
Read the whole thing. It's another good example of how minor technical changes with huge consequences get inserted into conference reports with no oversight from either the public or from Democrats. Only the lobbyists and the GOP know what's going on.
And it works pretty well. $22 billion is a pretty good payoff for the insurance industry's $24 million in contributions to Republicans during the 2004 election cycle, isn't it? And it all comes out of your pocketbook.
Yesterday, the Congressional Budget Office reported on the latest valentine from the GOP to the insurance industry. It turns out that Republicans met in closed session last month to make technical changes to a budget cutting bill that saved the industry $22 billion:
The Senate version would have targeted private HMOs participating in Medicare by changing the formula that governs their reimbursement, lowering payments $26 billion over the next decade. But after lobbying by the health insurance industry, the final version made a critical change that had the effect of eliminating all but $4 billion of the projected savings, according to CBO and other health policy experts.
...."It happens in the dead of night when lobbyists get a [Republican lawmaker] in the corner and say, 'We've got to have this,' " said Rep. Fortney "Pete" Stark (Calif.), the Democrats' point man on Medicare issues. "It's a pattern that just goes on and on, and at some point the public's going to rise up."
[Senate Finance Committee Chairman Charles] Grassley disputed the CBO's interpretation of the change as "ridiculous," dismissing what appears to be a major insurance industry victory as merely a mistake in CBO calculations, not a substantive policy change. He said he accepted the policy change because he "didn't see a big difference from the Senate position and the conference position."
Indeed. Not a "big difference." Then why did the insurance industry lobby so desperately to get it passed?
Read the whole thing. It's another good example of how minor technical changes with huge consequences get inserted into conference reports with no oversight from either the public or from Democrats. Only the lobbyists and the GOP know what's going on.
And it works pretty well. $22 billion is a pretty good payoff for the insurance industry's $24 million in contributions to Republicans during the 2004 election cycle, isn't it? And it all comes out of your pocketbook.
Tuesday, January 24, 2006
Bush will push health savings accounts
President Bush's Bold Proposal for 2006 is apparently going to be Health Savings Accounts, a half-baked pseudo-solution to the healthcare crisis that sounds intriguing primarily to people who are young and healthy and therefore don't think they're going to need much health care. That's just the right target audience for a health care plan, isn't it?
Technically, the idea behind HSAs is that you put, say, $2,000 in a tax-free account and then buy a health plan that doesn't pay anything until your expenses exceed $2,000. You pay for your normal health care expenses by drawing money out of the HSA, and if there's any left over at the end of the year you get to keep it. Ezra has more about it here.
For the quick and dirty explanation behind HSAs, here is Peter Gosselin in the LA Times this morning:
Most conservatives — including those in the administration — believe that the root cause of most problems with the nation's health care system is that most Americans are over-insured.
The debate over HSAs is going to get mighty wonky over the next few months, but always keep this explanation in mind as you're trying to make sense of the charges and countercharges. The fundamental idea behind HSAs is not to provide better healthcare, it's to provide less healthcare. Conservatives want you to think twice before spending a hundred bucks for your regular pap smear.
I'm probably going to write enough about HSAs over the next few months to make everyone scream for mercy, especially since I assume the White House will decline to publish an actual plan, leaving us instead to speculate wildly about what they really have in mind. So I'm going to wrap up this post right here. Just remember: If you think more risk, more complexity, and less healthcare are the answer, HSAs are for you. The rest of us will keep pushing for something that actually makes sense.
Technically, the idea behind HSAs is that you put, say, $2,000 in a tax-free account and then buy a health plan that doesn't pay anything until your expenses exceed $2,000. You pay for your normal health care expenses by drawing money out of the HSA, and if there's any left over at the end of the year you get to keep it. Ezra has more about it here.
For the quick and dirty explanation behind HSAs, here is Peter Gosselin in the LA Times this morning:
Most conservatives — including those in the administration — believe that the root cause of most problems with the nation's health care system is that most Americans are over-insured.
The debate over HSAs is going to get mighty wonky over the next few months, but always keep this explanation in mind as you're trying to make sense of the charges and countercharges. The fundamental idea behind HSAs is not to provide better healthcare, it's to provide less healthcare. Conservatives want you to think twice before spending a hundred bucks for your regular pap smear.
I'm probably going to write enough about HSAs over the next few months to make everyone scream for mercy, especially since I assume the White House will decline to publish an actual plan, leaving us instead to speculate wildly about what they really have in mind. So I'm going to wrap up this post right here. Just remember: If you think more risk, more complexity, and less healthcare are the answer, HSAs are for you. The rest of us will keep pushing for something that actually makes sense.
The Part D doughnut hole
Speaking of making healthcare more complicated, Michael Hiltzik has another column about George Bush's Medicare prescription drug debacle today:
Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example.
Of the 48 commercial Medicare drug plans offered in Southern California, three don't cover Actonel at all; their enrollees will have to pay full price. Twenty-eight plans require prior authorization. The remaining 17 plans cover the drug, no questions asked.
That's not all. There's wide variation in how much each plan charges for a month's supply. Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602....[But] any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash — spending slightly more for a year's supply than some plans charge for a month.
The column is mainly about the absurd and cynical "doughnut hole" built into Bush's prescription drug plan — the result of policymakers who don't actually care about healthcare policy combined with lawmakers who don't care about anything except pretending that their plan costs less than it actually does. In other words, it's the toxic intersection of incompetence and venality.
Read the whole thing.
Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example.
Of the 48 commercial Medicare drug plans offered in Southern California, three don't cover Actonel at all; their enrollees will have to pay full price. Twenty-eight plans require prior authorization. The remaining 17 plans cover the drug, no questions asked.
That's not all. There's wide variation in how much each plan charges for a month's supply. Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602....[But] any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash — spending slightly more for a year's supply than some plans charge for a month.
The column is mainly about the absurd and cynical "doughnut hole" built into Bush's prescription drug plan — the result of policymakers who don't actually care about healthcare policy combined with lawmakers who don't care about anything except pretending that their plan costs less than it actually does. In other words, it's the toxic intersection of incompetence and venality.
Read the whole thing.
Wednesday, January 18, 2006
GAO warned of Part D failure; CMS blew it off
Here's a Government Accounting Office report, issued in December, warning that the Bush administration hadn't done enough to make sure the most medically and financially vulnerable Medicare beneficiaries could actually get their drugs. As we've seen over the past two weeks, the GAO was exactly right.
If you do get around to reading it, make sure to check out the part where Mark McClellan, director of the Center for Medicare and Medicaid Services, says the GAO has it all wrong — the part where he insists that "CMS has established effective contingency plans to ensure that dual-eligible beneficiaries will be able to obtain comprehensive coverage and obtain necessary drugs beginning January 1, 2006."
You know, that sounds familiar. The Bush administration is warned that its planning is inadequate but it ignores the advice and plows ahead without listening. Verrrrrry familiar. It's on the tip of my tongue.... Hmmmmm... Help me out here.
If you do get around to reading it, make sure to check out the part where Mark McClellan, director of the Center for Medicare and Medicaid Services, says the GAO has it all wrong — the part where he insists that "CMS has established effective contingency plans to ensure that dual-eligible beneficiaries will be able to obtain comprehensive coverage and obtain necessary drugs beginning January 1, 2006."
You know, that sounds familiar. The Bush administration is warned that its planning is inadequate but it ignores the advice and plows ahead without listening. Verrrrrry familiar. It's on the tip of my tongue.... Hmmmmm... Help me out here.
Tuesday, January 17, 2006
Bush orders insurers to cover Part D meds for 30 days
The Bush administration has ordered insurers to provide a temporary 30-day supply of medicines to Medicare Part D recipients in an effort to control growing problems. The White House also ordered co-pays for low income seniors to be capped at $5 per prescription. The move is seen as an admission that things are not going as smoothly as they could be. Over the weekend, Centers for Medicare and Medicaid Services administrator Dr. Mark McClellan conceded that "thousands" of program recipients have been denied access to their prescriptions in the benefit's first week. Widespread problems have led many states to take action to ensure that those who need medicines get them.
Supreme Court upholds assisted suicide law
The Supreme Court, with Chief Justice John Roberts dissenting, upheld Oregon's one-of-a-kind physician-assisted suicide law Tuesday, rejecting a Bush administration attempt to punish doctors who help terminally ill patients die. Justices, on a 6-3 vote, said the 1997 Oregon law used to end the lives of more than 200 seriously ill people trumped federal authority to regulate doctors.
That means the administration improperly tried to use a federal drug law to prosecute Oregon doctors who prescribe overdoses. Then-Attorney General John Ashcroft vowed to do that in 2001, saying that doctor-assisted suicide is not a "legitimate medical purpose."
Justice Anthony Kennedy, writing for the majority, said the federal government does, indeed, have the authority to go after drug dealers and pass rules for health and safety.
But Oregon's law covers only extremely sick people -- those with incurable diseases, whom at least two doctors agree have six months or less to live and are of sound mind.
Tuesday's decision is a reprimand of sorts for Ashcroft. Kennedy said the "authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design."
"The authority desired by the government is inconsistent with the design of the statute in other fundamental respects. The attorney general does not have the sole delegated authority under the (law)," Kennedy wrote for himself, retiring Justice Sandra Day O'Connor and Justices John Paul Stevens, David Souter, and Ruth Bader Ginsburg, and Stephen Breyer.
Roberts and Justices Clarence Thomas and Antonin Scalia dissented. (If you're keeping score, this will be one that the addition of Alito will not be able to overturn.)
Scalia, writing the dissent, said that federal officials have the power to regulate the doling out of medicine.
"If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death," he wrote.
The ruling backed a decision by the 9th U.S. Circuit Court of Appeals, which said Ashcroft's "unilateral attempt to regulate general medical practices historically entrusted to state lawmakers interferes with the democratic debate about physician-assisted suicide."
Ashcroft had brought the case to the Supreme Court on the day his resignation was announced by the White House in 2004. The Justice Department has continued the case, under the leadership of his successor, Attorney General Alberto Gonzales.
That means the administration improperly tried to use a federal drug law to prosecute Oregon doctors who prescribe overdoses. Then-Attorney General John Ashcroft vowed to do that in 2001, saying that doctor-assisted suicide is not a "legitimate medical purpose."
Justice Anthony Kennedy, writing for the majority, said the federal government does, indeed, have the authority to go after drug dealers and pass rules for health and safety.
But Oregon's law covers only extremely sick people -- those with incurable diseases, whom at least two doctors agree have six months or less to live and are of sound mind.
Tuesday's decision is a reprimand of sorts for Ashcroft. Kennedy said the "authority claimed by the attorney general is both beyond his expertise and incongruous with the statutory purposes and design."
"The authority desired by the government is inconsistent with the design of the statute in other fundamental respects. The attorney general does not have the sole delegated authority under the (law)," Kennedy wrote for himself, retiring Justice Sandra Day O'Connor and Justices John Paul Stevens, David Souter, and Ruth Bader Ginsburg, and Stephen Breyer.
Roberts and Justices Clarence Thomas and Antonin Scalia dissented. (If you're keeping score, this will be one that the addition of Alito will not be able to overturn.)
Scalia, writing the dissent, said that federal officials have the power to regulate the doling out of medicine.
"If the term 'legitimate medical purpose' has any meaning, it surely excludes the prescription of drugs to produce death," he wrote.
The ruling backed a decision by the 9th U.S. Circuit Court of Appeals, which said Ashcroft's "unilateral attempt to regulate general medical practices historically entrusted to state lawmakers interferes with the democratic debate about physician-assisted suicide."
Ashcroft had brought the case to the Supreme Court on the day his resignation was announced by the White House in 2004. The Justice Department has continued the case, under the leadership of his successor, Attorney General Alberto Gonzales.
Friday, January 13, 2006
Priorities: health care or politics?
With reports of widespread failure by the federal government to properly enroll seniors in the Medicare Part D program, Governor Doyle announced today emergency measures to ensure seniors and people with disabilities in Wisconsin get the life-saving drugs they need. Elsewhere, it's good to see Republican administrations taking the actual administration of federal programs so seriously:
California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program.
Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program.
In Illinois, Gov. Rod Blagojevich, a Democrat, took action similar to Schwarzenegger's, ordering state funds to be used to provide emergency drug coverage for the elderly. Arkansas Gov. Mike Huckabee, a leading figure among Republican governors on health policy issues, took a similar step Wednesday. Nine states, including Wisconsin, have stepped in to fill the gaps in the federal program.
If George Bush and Karl Rove spent half as much time on the actual governance of the country as they do on figuring out new ways to portray Democrats as weak-kneed terrorist appeasers, seniors might be getting their drugs. But we all have our priorities.
California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program.
Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program.
In Illinois, Gov. Rod Blagojevich, a Democrat, took action similar to Schwarzenegger's, ordering state funds to be used to provide emergency drug coverage for the elderly. Arkansas Gov. Mike Huckabee, a leading figure among Republican governors on health policy issues, took a similar step Wednesday. Nine states, including Wisconsin, have stepped in to fill the gaps in the federal program.
If George Bush and Karl Rove spent half as much time on the actual governance of the country as they do on figuring out new ways to portray Democrats as weak-kneed terrorist appeasers, seniors might be getting their drugs. But we all have our priorities.
Thursday, January 12, 2006
Helping just doesn't pay
Let's start with the obvious: Chronic care is hard work, but some are asking whether it is worth the effort. Disease management programs are only partially effective because — even if you get it right — it goes against the incentives of doctors and hospitals (to do more, and more expensive, procedures) and health insurers (to get sick people off their rolls ASAP). In a long look at diabetes care, the NY Times comes up with the conclusion that In the Treatment of Diabetes, Success Often Does Not Pay. It‘s a long article but well worth a skim for those of you wondering what’s wrong with our health care system.
Wednesday, January 11, 2006
We're not alone: Medicare D crashes in other states too
Problems continued with the implementation of Medicare Part D, as more states said they are experiencing difficulties with the new prescription drug benefit's roll-out. At least six states are now offering recipients aid to help them to purchase needed medicines and others appear ready to launch similar programs. In Massachusetts, there were reports of patients being turned away from pharmacies, despite a pledge by state officials to cover the costs of all prescriptions.
- see this AP article http://lists.fiercemarkets.com/c.html?rtr=on&s=69l,hjiz,osy,lm5q,ekry,jgga,m74o
- and this article from the Boston Globe http://www.boston.com/business/globe/articles/2006/01/11/action_by_state_fails_to_fix_drug_plan_woes/
- see this AP article http://lists.fiercemarkets.com/c.html?rtr=on&s=69l,hjiz,osy,lm5q,ekry,jgga,m74o
- and this article from the Boston Globe http://www.boston.com/business/globe/articles/2006/01/11/action_by_state_fails_to_fix_drug_plan_woes/
Tuesday, January 10, 2006
Medicaid and the Machete Budget
Remember pre-election 2000 when Bush said that we shouldn't balance the budget on the backs of the poor? He was of course joking (and not just about the balancing part), as Bob Herbert points out in his article -- The Machete Budget.
Contrast the cuts in Medicaid that are in the latest budget with the $10m spent on a bahmitzvah party by a defense contractor who made $70m last year supplying apparently faulty flak-jackets to our troops. And they claim that there’s no war profiteering. Of course in WWII a real American hero, Harry Truman stopped that stuff dead in its tracks.
Contrast the cuts in Medicaid that are in the latest budget with the $10m spent on a bahmitzvah party by a defense contractor who made $70m last year supplying apparently faulty flak-jackets to our troops. And they claim that there’s no war profiteering. Of course in WWII a real American hero, Harry Truman stopped that stuff dead in its tracks.
More garbage about Canada
An apparently well funded website has decided to “take down” what it calls The Health Care Lies of Paul Krugman. You will quickly have fun spotting the errors, the total bias, and the thinly veiled racism. Of course if you want to know something real and researched about the subject you could do worse than read this.
Will Medicare Part D secretly save us?
The thing that strikes me as almost amusingly ironic about Medicare Part D is that it shows the folly of leaving economic planning to the monopolistic corporations. The US throughout its history has disdained strategic economic planning by government because of the secular faith in the market among the country’s business leaders. So here we have the Medicare Modernization Act as developed by Big Pharma’s Pfizers, Mercks and their PhRMA lobby.
They fashioned the MMA, with its confusing, competing PDPs, specifically to prevent Medicare from acting as a single payer that could make volume discount purchases. After all, if they could elect George by manipulating an electoral system to create the illusion that 3,000 elderly Jews in Florida voted for Pat Buchanan, a Rube Goldberg MMA could certainly boost their earnings at taxpayers’ expense.
Now here we have consultants, journalists and equity analysts forecasting that by decade’s end, the MMA will do precisely what the CEO malefactors wanted to avoid -- that is push the US closer to the rest of the world in terms of a national payer system, greater transparency in drug pricing and cost constraints. I dread to think what would happen if Big Pharma’s CEOs were half as bright as their sycophants in Pharmaceutical Executive and the other vanity rags claim.
By the way, the crew running big Pharma in 2003 will be long gone counting their millions by the time those chickens come home to their successors’ roosts.
They fashioned the MMA, with its confusing, competing PDPs, specifically to prevent Medicare from acting as a single payer that could make volume discount purchases. After all, if they could elect George by manipulating an electoral system to create the illusion that 3,000 elderly Jews in Florida voted for Pat Buchanan, a Rube Goldberg MMA could certainly boost their earnings at taxpayers’ expense.
Now here we have consultants, journalists and equity analysts forecasting that by decade’s end, the MMA will do precisely what the CEO malefactors wanted to avoid -- that is push the US closer to the rest of the world in terms of a national payer system, greater transparency in drug pricing and cost constraints. I dread to think what would happen if Big Pharma’s CEOs were half as bright as their sycophants in Pharmaceutical Executive and the other vanity rags claim.
By the way, the crew running big Pharma in 2003 will be long gone counting their millions by the time those chickens come home to their successors’ roosts.
The federal guvmint: No pain no gain
Finally there is some word getting out about the reign of terror the DEA has been running against pain doctors and its awful impact. This article, called Let's Get Serious About Relieving Chronic Pain has some important news. We have known at least since the HHS report in the early 1990s that pain medication is massively under-prescribed. In this article, Jane Brody notes that: "Pain is a common symptom in patients nearing the end of life," with up to "77 percent of patients suffering unrelieved, pronounced pain during the last year of life," Dr. Timothy J. Moynihan wrote in The Mayo Clinic Proceedings in 2003.
But the news is that the DEA, on its messianic quest to prevent us all going to hell or whatever the theocratic fascists think they’re doing, is not only wasting our time and money, and condemning innocent doctors and patients to prison. They are also helping most people to suffer in their last year of life. Well I’m sure the DEA think it’s a deal worth taking, but I can’t believe any rational person does.
But the news is that the DEA, on its messianic quest to prevent us all going to hell or whatever the theocratic fascists think they’re doing, is not only wasting our time and money, and condemning innocent doctors and patients to prison. They are also helping most people to suffer in their last year of life. Well I’m sure the DEA think it’s a deal worth taking, but I can’t believe any rational person does.
Tantalus health care
For those of you keeping score at home the count is now $1.9 trillion spent on health care in the US — an average of $6,280 a person, and 16 percent of GDP. Another area in which America proudly leads the world! Heh.
The rate of growth in health spending slowed in 2004, but it's still substantially higher than trends in earnings, which are the key to being able to afford health care. Health insurance is becoming less affordable to more people. As usual, health spending grew faster than the economy or consumer prices. The Consumer Price Index, a widely used measure of inflation, increased 3.3 percent in 2004.
The rate of growth in health spending slowed in 2004, but it's still substantially higher than trends in earnings, which are the key to being able to afford health care. Health insurance is becoming less affordable to more people. As usual, health spending grew faster than the economy or consumer prices. The Consumer Price Index, a widely used measure of inflation, increased 3.3 percent in 2004.
Wednesday, January 04, 2006
Medicare reform becomes Medicare deform
It was clear back in 2003, when the Bush administration rammed the Medicare drug benefit bill through the Republican Congress, that the purpose was not to devise an affordable prescription drug program for seniors. Rather the administration wanted to help two friendly industries, the pharmaceutical companies and the HMO’s; and to get bragging rights for the 2004 election that Bush had helped seniors. Few voters would grasp just how bad the law was, since its effective date was deliberately put off until 2006.
Now, as the year of reckoning arrives, the true cynicism of Bush’s program is becoming evident to each senior citizen (or adult child of senior citizen) who attempts to fathom what Bush and the industry lobbyists wrought.
For starters, coverage is woefully inadequate. You pay a $250 deductible and then a 25 percent co-pay on the first $2,250 of drug benefits each year, plus roughly another $450 a year in premiums. So if your prescriptions cost $2,250 a year, or about $190 a month, for prescriptions, you pay $1,200 a year all told and the plan pays just $1050.
That’s pretty shabby. But then, the truly bizarre feature of the plan kicks in. Coverage simply disappears, until you have spent nearly $3,100 out of pocket. This is the infamous "hole in the donut." Coverage kicks in again only after a total of $5,100 in prescription costs.
A great many seniors will never get the coverage because the plan is a bad bargain, and they just won’t sign up. Of if they do sign up, they will run out of the ability to pay enough out of pocket before qualifying for needed benefits. Even with these disgracefully skimpy benefits, the plan is expected to add over half a trillion to the federal budget over the next decade.
Why would anyone have designed such an insane program?
Because the political purpose was never to deliver good benefits. One administration goal, running the program through the private insurance industry, conflicted with the imperative of a clear, cost-effective plan. Seniors must evaluate innumerable competing private plans, each with subtle differences in costs and benefits that make an impenetrable program even less fathomable, and raise total costs because each of these private plans tacks on a profit. This was a case of privatizing something done far more efficiently through a direct government program.
An aside on absurdity: The conspiracy nut in me wonders whether the overwhelming confusion of competing plans and fine details was another way to scare away senior citizens, to keep them from actually using the benefit. Why? Because all the noise and static is in written material aimed at an age group that has 40% of its members in the lowest literacy rate (below a 5th grade reading level, which is insufficient even to read a prescription label).
Low functional literacy has serious consequences for individual health and places added demands on the health care system. People in this group are less likely to understand written or verbal information from their health care providers, to follow medication directions or appointment schedules, or to navigate the health system successfully to obtain needed care. A number of studies of patients lacking functional health literacy have found that those individuals lack essential information about their specific conditions (Williams, Baker, Honig, & Lee, 1998; Williams, Baker, Parker, & Nurss, 1998), are at risk for increased hospitalization (Baker, Parker, Williams, & Clark, 1998), and feel shame further hampering their access to care (Baker et al., 1996). Low functional health literacy among the elderly is of particular concern. This has been identified an issue even for those elderly that are more affluent and educated than the national norm (Benson & Forman, 2002).
The second administration goal, fattening the drug industry, led to a provision explicitly prohibiting the government from negotiating bulk price discounts from drug companies, as the Veterans hospitals do. As a result, according to a study by Families USA, drug prices obtained by the VA are about 48 percent less on average than those expected to be charged to people enrolled in the Medicare drug program. Among the 20 most widely prescribed drugs for seniors, for instance, a year’s supply of Protonix (for ulcers) costs the VA $253, but the seniors in the Bush Medicare program, which prohibits such bulk discounts, pay a sticker price of $1,080. That will give you ulcers! A year of Zocor, the cholesterol-reducing drug, costs the VA $251. Seniors in Bush’s drug plan get whacked for $1,323. It was these inflated costs that necessitated some gimmick to keep down the overall cost to taxpaypers. Hence the notorious donut hole.
What to do, for any politician with the moxie and the wit: get rid of the costly crazy-quilt of private programs and bring the "Medicare" drug program back into public Medicare; allow Medicare to negotiate bulk discounts the way the VA does; get rid of the donut hole, and design a simplified benefit structure with modest co-pays and then 100 percent coverage after a set annual cap on out-of-pocket costs (if the savings from the bulk price discounts are not quite sufficient to cover costs of filling in the donut hole, take back a little of Bush’s tax cuts to the richest one percent.)
Sometimes the right thing to do isn't all that tough to see.
Now, as the year of reckoning arrives, the true cynicism of Bush’s program is becoming evident to each senior citizen (or adult child of senior citizen) who attempts to fathom what Bush and the industry lobbyists wrought.
For starters, coverage is woefully inadequate. You pay a $250 deductible and then a 25 percent co-pay on the first $2,250 of drug benefits each year, plus roughly another $450 a year in premiums. So if your prescriptions cost $2,250 a year, or about $190 a month, for prescriptions, you pay $1,200 a year all told and the plan pays just $1050.
That’s pretty shabby. But then, the truly bizarre feature of the plan kicks in. Coverage simply disappears, until you have spent nearly $3,100 out of pocket. This is the infamous "hole in the donut." Coverage kicks in again only after a total of $5,100 in prescription costs.
A great many seniors will never get the coverage because the plan is a bad bargain, and they just won’t sign up. Of if they do sign up, they will run out of the ability to pay enough out of pocket before qualifying for needed benefits. Even with these disgracefully skimpy benefits, the plan is expected to add over half a trillion to the federal budget over the next decade.
Why would anyone have designed such an insane program?
Because the political purpose was never to deliver good benefits. One administration goal, running the program through the private insurance industry, conflicted with the imperative of a clear, cost-effective plan. Seniors must evaluate innumerable competing private plans, each with subtle differences in costs and benefits that make an impenetrable program even less fathomable, and raise total costs because each of these private plans tacks on a profit. This was a case of privatizing something done far more efficiently through a direct government program.
An aside on absurdity: The conspiracy nut in me wonders whether the overwhelming confusion of competing plans and fine details was another way to scare away senior citizens, to keep them from actually using the benefit. Why? Because all the noise and static is in written material aimed at an age group that has 40% of its members in the lowest literacy rate (below a 5th grade reading level, which is insufficient even to read a prescription label).
Low functional literacy has serious consequences for individual health and places added demands on the health care system. People in this group are less likely to understand written or verbal information from their health care providers, to follow medication directions or appointment schedules, or to navigate the health system successfully to obtain needed care. A number of studies of patients lacking functional health literacy have found that those individuals lack essential information about their specific conditions (Williams, Baker, Honig, & Lee, 1998; Williams, Baker, Parker, & Nurss, 1998), are at risk for increased hospitalization (Baker, Parker, Williams, & Clark, 1998), and feel shame further hampering their access to care (Baker et al., 1996). Low functional health literacy among the elderly is of particular concern. This has been identified an issue even for those elderly that are more affluent and educated than the national norm (Benson & Forman, 2002).
The second administration goal, fattening the drug industry, led to a provision explicitly prohibiting the government from negotiating bulk price discounts from drug companies, as the Veterans hospitals do. As a result, according to a study by Families USA, drug prices obtained by the VA are about 48 percent less on average than those expected to be charged to people enrolled in the Medicare drug program. Among the 20 most widely prescribed drugs for seniors, for instance, a year’s supply of Protonix (for ulcers) costs the VA $253, but the seniors in the Bush Medicare program, which prohibits such bulk discounts, pay a sticker price of $1,080. That will give you ulcers! A year of Zocor, the cholesterol-reducing drug, costs the VA $251. Seniors in Bush’s drug plan get whacked for $1,323. It was these inflated costs that necessitated some gimmick to keep down the overall cost to taxpaypers. Hence the notorious donut hole.
What to do, for any politician with the moxie and the wit: get rid of the costly crazy-quilt of private programs and bring the "Medicare" drug program back into public Medicare; allow Medicare to negotiate bulk discounts the way the VA does; get rid of the donut hole, and design a simplified benefit structure with modest co-pays and then 100 percent coverage after a set annual cap on out-of-pocket costs (if the savings from the bulk price discounts are not quite sufficient to cover costs of filling in the donut hole, take back a little of Bush’s tax cuts to the richest one percent.)
Sometimes the right thing to do isn't all that tough to see.
Two bills to keep your eye on
Two pieces of legislation to make Wisconsin’s tax system fairer were introduced last month, and they deserve our attention -- one because it will directly help home care patients, the other because it could help fill the Medicaid funding hole.
The first bill would exempt over-the-counter medicines from the 5% state sales tax, which is now costing Wisconsin residents about $27 million a year. As more and more medicines that were once sold by prescription only become over-the-counter drugs, this change increases in importance.
The second bill would close a major corporate tax break known as the “Las Vegas Loophole” that lets Wisconsin corporations shift profits to states without a state corporate income tax. This usually involves setting up a dummy corporation in Nevada to avoid paying Wisconsin taxes. One scenario goes like this: I create a company in Nevada which exists as nothing more than paperwork and a PO box, then I "rent" the use of the name of my Wisconsin company (the real one) from the Nevada company (the fake one) for slightly more than my Wisconsin company's profits. "Poof!" goes by Wisconsin tax bill.
According to the Department of Revenue, the Las Vegas Loophole costs the state as much as $260 million a year. Think of the number of frail elderly and disabled in our state who could benefit from $260 million more in Medicaid home care services. The immorality of the loophole -- and the people who make use of it -- is staggering.
The first bill would exempt over-the-counter medicines from the 5% state sales tax, which is now costing Wisconsin residents about $27 million a year. As more and more medicines that were once sold by prescription only become over-the-counter drugs, this change increases in importance.
The second bill would close a major corporate tax break known as the “Las Vegas Loophole” that lets Wisconsin corporations shift profits to states without a state corporate income tax. This usually involves setting up a dummy corporation in Nevada to avoid paying Wisconsin taxes. One scenario goes like this: I create a company in Nevada which exists as nothing more than paperwork and a PO box, then I "rent" the use of the name of my Wisconsin company (the real one) from the Nevada company (the fake one) for slightly more than my Wisconsin company's profits. "Poof!" goes by Wisconsin tax bill.
According to the Department of Revenue, the Las Vegas Loophole costs the state as much as $260 million a year. Think of the number of frail elderly and disabled in our state who could benefit from $260 million more in Medicaid home care services. The immorality of the loophole -- and the people who make use of it -- is staggering.
