The Great Republican Rip-Off

[Secret Squirrel]

Once again, we have mob scenes of citizens begging for direction from their inept federal government. The botched launch of the Medicare drug benefit may not match the muddled response to Katrina in total tragedy, but it is causing trips to emergency rooms. Meanwhile, alarmed state officials are setting up crisis centers to ensure a continued flow of pills to their elderly and disabled populations.

How much more of this can the voters take? The Republicans running Washington are incapable of either designing a rational program or implementing it. And for all their talk of being the party of national security, you wonder how they would handle an unexpected terrorist attack when they can’t even organize a drug plan with more than a year’s lead time.

Many seniors who signed up for the program are learning that they are nowhere to be found in the government’s computers. Pharmacists can’t locate the needed billing information to fill prescriptions. And people calling the Medicare hotline face hour-long waits to speak to a human being.

The situation is even more frantic for low-income Medicaid patients, whose drug needs are now supposed to be met by Medicare. Some are being charged $30 for a prescription they’re supposed to get for $3.

Usually, a government program that costs far more than necessary at least delivers gold-plated benefits with Swiss efficiency. But the Medicare drug benefits are mediocre. And Washington’s performance would be an embarrassment in a Third World country.

The notion that $724 billion should buy a pretty nifty program is based on the pre-Bush assumption that the objective was to help elderly Americans obtain their medications. At this price, you’d expect things to run as smoothly as a Microsoft annual meeting. And the Medicare hotline would be staffed by banks of velvet-voiced experts who answer on the first ring.

But the real mission was to force through another adventure in privatization. The Republicans’ idea of a “free market solution” is a government program that lets private companies siphon out billions—and hides the unremarkable level of benefits in the fog of “choice.”

When you look at the program from the corporate point of view, it is a model of K Street efficiency: Insurance and drug company lobbyists hire Republicans and fill GOP campaign coffers. In return, they get to write the legislation to their liking. From this perspective, the drug benefit is working like a charm.

The drug companies were able to insert a provision that forbids the federal government to buy drugs in bulk at a negotiated price. And by dividing the purchasing power among hundreds of insurance companies, each with far less clout than the government, they can reap higher prices for their products.

The insurance companies, meanwhile, got their piece of the action. They manage the drug benefits. And because their plans can come with different premiums, deductibles and co-payments—and offer different lists of drugs, which the insurers can change—beneficiaries have no way to effectively compare the options. There’s profit in confusion.

Republicans in government did well, too. Rep. Billy Tauzin was the Louisiana Republican who drew up the legislation. Immediately after passage, he left Congress to work for the drug lobbyists. His job at the Pharmaceutical Research and Manufacturers of America pays an estimated $3 million a year. Thomas Scully, Bush’s point man on the drug bill, beat Tauzin through the revolving door, and joined a law firm that lobbies for drug companies.

It did not have to be this way. During the 2000 presidential campaign, Democrat Al Gore had proposed a simple drug benefit that would have been delivered by Medicare—and not outsourced to private companies. His estimated a price tag of $253 billion over 10 years drew condemnations from Republican ranks. “Mr. Gore seems unconcerned about costs,” the Wall Street Journal sniffed.

To counter the Gore drug-benefit plan, Bush offered voters his privatized version—pulling out of his hat a price tag of $158 billion. When he pushed his plan to Congress in 2003, the number had risen to $400 billion. At the time, a government actuary had determined that the program would cost a lot more than $400 billion, but he shut up after Scully threatened his job. And so taxpayers are now looking at a $724 billion bill.

Note that the corporate players have little incentive to save the taxpayers money. For example, mentally ill people denied their medications are showing in emergency rooms at great expense to the public. But the companies managing their benefits aren’t charged a dime for these unnecessary hospitalizations.

Outside of the business interests raking in money, how do Americans feel about the Medicare drug benefit?

Most of the beneficiaries it’s supposed to serve are giving the program a wide berth. Fewer than one in five people eligible for the stand-alone program have signed up for it. Some have decided that they can get a better deal through the Veterans Administration or company plans or Canada. Others have just thrown up their hands in frustration over the program’s complexity. The post-launch breakdown is certainly not a great advertisement for the folks holding back.

The taxpayers are only now waking up to the rip-off. They’ve been scammed like rubes at a carnival sideshow. Learning that one has just bought a used Vespa for the price of Porsche is not a nice feeling.

If Americans have any self-esteem left, they are going to express their displeasure at the polls in November. In politics as in business, angry customers usually bring about a change in management.

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[micronazi]

First, the new medicare drug coverage was passed by congress, which means that democrats voted for it too. Second, it's not up to the "Federal" government to implement the system. It is up to the Centers for Medicare and Medicaid to implement and negotiate with private insurance carriers. This whole, "Wah, republicans." Bull**** is not necessary. There are more people at fault with this whole thing than just one political party. Stupid propaganda and partisan sawying crap. Does anyone around here have any idea how hard it must be to implement a major national revision to a national health coverage plan...THAT IS REGULATED BY THE STATE? I don't, but I'm sure it's not easy.

Regards,
micronazi

[ed316]

Wow, an Article written by a known liberal and from a liberal website. HMMMMMMMMMMMMMMMMMMMMMMm????

[Secret Squirrel]

Perhaps Medicare's drug benefit isn't working very well because those who conceived it don't like Medicare.

Nothing else explains why Part D isn't really Medicare. It has the Medicare label because Republicans couldn't have sold it in December 2003 under any other name. Part D, which began this month, looks more and more like a campaign by private-sector evangelists to convert Medicare.

If expanding Medicare had been the priority, Congress would have made Part D, well, part of Medicare, just as Part A covers hospitalization and Part B covers visits to the doctor. There would be one simple choice for coverage, not four dozen. There would be no coverage-gap "doughnut hole." Medicare would have kept the costs down by using its bulk-buying power, as the Veterans Administration does.

Instead, there are subsidies for private insurers to participate. There are subsidies for private companies if they continue to cover retirees' drug purchases. There are subsidies for unions to cover retired members' medicine. There are subsidies for the pharmaceutical companies. In short, there are subsidies to keep retirees in private plans, and there are subsidies to push retirees into private plans.

A little honesty would be nice

We can debate whether this approach will turn out to be good or bad. It would be better, though, if the government were honest about what is happening. When Medicare became law four decades ago, Republicans and lots of doctors called it "socialized medicine." That sentiment persists among many in this generation of Republicans, who saw the chance to score points with retirees before President Bush ran for reelection and to try a grand privatization experiment.

At this point, there are explosions in the lab. Thursday's story in The Post was just one of many across the country to report confusion and frustration among some patients and pharmacists. At least 22 states will pay for drugs that poor people can't afford because the changeover fouled up their eligibility. Neighborhood pharmacies worry that they won't be reimbursed.

Again, though, patients weren't the priority. Consider what happened to Thomas Scully and Billy Tauzin. Mr. Scully ran the Medicare program for Mr. Bush. Ten days after Congress passed the bill, he left to lobby on behalf of health-care companies. Mr. Tauzin, a former representative, got the bill through the House and now earns about $2 million a year as chief lobbyist for the drug industry trade group.

The people running Medicare say that everything will work out. You keep waiting for Centers for Medicare & Medicaid Services Administrator Mark McClellan to say that Part D's problems are in their "last throes." In fact, Medicare beneficiaries who don't take many prescriptions and can navigate the Part D Web site or have someone do it for them may not have had many problems signing up. But later?

Mess might be worse later

In the mid-1990s, private insurers began offering seniors Medicare HMO plans that included drug coverage. As the insurers saw their costs rise, they began dumping patients, claiming that the government wasn't reimbursing them sufficiently to make a profit.

So for all the current problems with Medicare Part D, the real tests will come after the first and second year because of the risk from placing the program in private hands. If the bottom line doesn't look good, companies might exclude some drugs from coverage. They might raise premiums or deductibles. Beneficiaries can switch plans each year, but companies can change what they cover in midyear and Part D prohibits seniors from buying policies to cover gaps in drug coverage as some do for Medicare parts A and B.

Six years ago, then-Sen. Bob Graham tried to get a simple — one plan — Medicare drug benefit through Congress. Republicans killed it because they wanted private insurers to provide the coverage. With Medicare Part D, Republicans are relying on the Medicare HMO model that failed. The difference is that they added all those subsidies, which — without savings from bulk buying — ran the cost projection so high that Mr. Scully told Medicare's chief actuary to lowball it.

While pushing seniors into private drug coverage, Medicare also is urging them to consider enrolling in Medicare Advantage, the private version of Medicare's hospital and doctor coverage. The evangelists are getting warmed up for the next sermon.

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[pathfinder82]

Yeah hows it feel to have it crammed down your throat like you conservatives continually do here. You bitch about this, gimme a break.

All that was written is basically spot on, its hard to swallow for some though.

Of course democrats voted for it, you can only stand up to it for so long before political pressure makes you give way. I mean thats what politics has become in this country and especially with this strong arm admin.

To the conservatives this is the can do no wrong administration. I guess the majority of the planet is misguided and the conservatives that hold a small majority in this country are right.

[micronazi]

Don't get me wrong, I'm not necessarily a big fan of the new coverage plans, but it does hold some benefits to a certain demographic of people. I'd rather there not be the "do-nut" whole and lack of coverage until you reach a certain ceiling, but that is what was voted on. My complaint with the article is the extreme partisan bias.

On the not of the recent article, the Part D portion offers patients more flexibility by allowing them to use private carriers with comparable or better service plans while still using portions of medicare. If I'm not mistaken you can still have Medicare as your primary carrier and the private company as your secondary.

There are a lot grey areas and such with the new program, but again, there are a lot benefits too.

Regards,
micronazi

[micronazi]

Yeah hows it feel to have it crammed down your throat like you conservatives continually do here. You bitch about this, gimme a break.

All that was written is basically spot on, its hard to swallow for some though.

Of course democrats voted for it, you can only stand up to it for so long before political pressure makes you give way. I mean thats what politics has become in this country and especially with this strong arm admin.

To the conservatives this is the can do no wrong administration. I guess the majority of the planet is misguided and the conservatives that hold a small majority in this country are right.

I suppose your tone equals that of mine in my first post, but make no mistake, I'm not Republican or Democrat. I hold no partisan loyalties. I don't like biased media from either side. Honestly though more conservative things I tend to agree with, but bias is never better than being objective. Hell, I'm not even registered to vote and I have been old enough for 4 years now. Lack of choice in my opinion.

Despite all of that, the article has some valid points, it's just I don't like the blame game and slandering it's using. it turns the article into a partisan propaganda tool rather than an objective, well put together tool for sharing information and awareness.

Regards,
micronazi

[ogukuo72]

There are two kinds of people: those that get up and do things, and those that sit back and whine about things.

If think the system is broke, you get up and organise a new system for your neighbourhood, then your area, then your county, then your state, etc..

My $0.02 worth.

[seva108]

There are two kinds of people: those that get up and do things, and those that sit back and whine about things.

If think the system is broke, you get up and organise a new system for your neighbourhood, then your area, then your county, then your state, etc..

My $0.02 worth.

Wrong ogukuo, the FEDERAL GOVERNMENT is the answer to all your woes. If it wasn't for Bush, you'd be happy now.

Now sit back and have good whine, and tax everyone more. Then things will improve.

[KB]

Wow, an Article written by a known liberal and from a liberal website. HMMMMMMMMMMMMMMMMMMMMMMm????

Its a nice contrast from all of the right wing, blinders on nut job publications that get quoted here so often.