Lawyers, Drugs and Money

This link (via Atrios) takes you to a story that notes the Democrats are going to present today their alternative to the Republican boondoggle of a Medicare drug plan that took effect on January 1st of this year (I’ve been saving a bunch of stuff on this, and it looks like I’ll finally be able to use it – long one coming up).

As noted in the NC Times link:

The Democrats envision using the money that is saved to close a gap in coverage, called the "doughnut hole” (I’ll explain in a second or two) that will affect an estimated 6.9 million people this year.

And…

Overall, about 43 million elderly and disabled Americans are eligible to participate in the Medicare benefit. An estimated 4.5 million to 5 million beneficiaries do not have prescription drug coverage.

Based on what I can determine, the two biggest issues facing the Medicare Part D drug benefit are the “doughnut hole” (which occurs between the cost ceiling of $2,250 where the subsidy stops and the $3,600 figure where it resumes, with the government picking up 95 percent of the purchase from that point) and the inability of Part D participants to buy drugs in bulk, which would result in cost savings (Patrick Murphy, among others, has pointed this out).

As the NC Times story also notes:

Democratic lawmakers contend that insurers do not have the clout the federal government would have when negotiating the purchase of medicine for seniors. They cited a study from the advocacy group, Families USA, which indicated that the Veterans Affairs prices for drugs were consistently lower than prices charged by Part D plans. The median price difference was 46 percent.

The Democrats said the savings that Medicare would gain through federal negotiations would be used to enhance coverage.

This story from The Nation provides some excellent background on Medicare Part D and how it came into existence. I think it’s important to keep in mind, as you read the article, that a scenario something like the one described in the story (with a wide range of players in the pharma and insurance industries marketing for customers) would be replicated to a certain point with financial services firms in the event that (God help us) Dubya and the Repugs are ever able to “privatize” Social Security, with all of the attendant confusion while the “big boys” make out like bandits as usual under this administration.

As the story tells us…

The government has allowed sellers to mold Part D coverage into hundreds of combinations of deductibles; co-insurance (a percentage of the drug cost consumers pay); drug utilization techniques (such as trying cheaper generic drugs first); and drug tiers, with their own dizzying array of co-payments (the flat amount consumers pay for each drug). Co-payments differ depending on whether people buy generics, preferred brand drugs, non-preferred brand drugs or specialty drugs--and depending on whether they buy from an in-network pharmacy where the insurer has negotiated good discounts or from an out-of-network pharmacy where it hasn't. Adding to the confusion is the fact that there's no standard nomenclature; sellers can use any fanciful name they think will lure buyers to their plan. They can also cover whatever drugs they want to; prescription formularies are not standardized either.

And what happens when seniors are understandably flummoxed by the overabundance of options? They're sent to a complicated web tool for answers--even though, according to one survey, three-quarters of seniors say they have never gone online.

The Nation story tells us that the two individuals who used to serve in the U.S. Congress (though they left for markedly different reasons) who are most responsible for Medicare Part D are former House speaker Tom DeLay (why did I KNOW he was involved somehow?) and former Louisiana Democratic Senator John Breaux. We know about “The Hammer” of course, but Breaux is one of these one-time “Third Way” guys who was a friend of Bill Clinton and took a nice, cushy payout when he left government, a la former U.S. House Rep. Jim Greenwood a lot closer to home. In fact, you can look at it this way; what former Clintonite Mike McCurry has morphed into for the telecoms (sadly) parallels what has happened with Breaux and Big Pharma.

Breaux is nobody’s fool, I’ll give him that, but I have a problem with his misrepresentation of Medicare Part D by conjuring up misty, yellowed “Great Society” memories of LBJ and passage of the original Medicare program in 1966 (as he does in this Inquirer opinion column from last month – registration required of course).

Another aspect of Medicare Part D which should be either modified or repealed outright, as noted in this link from The Century Foundation, is the asset test that determines whether or not seniors qualify for the Part D subsidy. Also, a deadline of May 15th had been imposed for enrollment, with anyone enrolling afterwards subject to penalties (why May 15th, I ask myself?), but in a stroke of sanity, that was abolished.

Here’s more on the asset test from The Century Foundation story:

Holding assets of more than $11,500—which include those readily convertible to cash such as stocks, bonds, mutual funds, IRAs, or equity in real estate--disqualifies seniors for subsidies. An even lower limit applies for the most generous subsidies. Fewer than one in three Medicare beneficiaries who have applied have been approved. UCLA School of Public Health professor Thomas Rice estimates that over half of those who have been denied have failed to pass the asset test. Of these, the majority exceed the amount of allowable assets by less than $35,000. Moreover, the application materials include questions about excludable assets like burial plots and insurance policies that appear further to have confused potential qualifiers.

William Novelli, the CEO of AARP, wrote a letter in late April to (Center for Medicaid and Medicare Services) administrator Mark McClellan urging him to end the asset test, calling it “cumbersome and unnecessary.” McClellan thus far has demurred on this point, questioning whether his agency has the authority to waive the requirement and whether the application form is truly onerous.

I guess when you’re as thoroughly immersed in the “wealth” perspective as Bushco is, it’s hard to understand that weighing burial plots as part of one’s accumulated assets over time when considering qualification for a drug subsidy is completely and totally ridiculous (and since we’re talking about Bushco, I should add that they’ve been completely honest and above board at all times when selling this mess to the American people).

This is an issue that affects all of us regardless of our age, by the way, since, God willing, as many of us as possible will reach an age where this issue will become absolutely crucial. We should make our opinions heard about this and support candidates who represent us on this issue as well as the Iraq War, the economy, and impeachment (which is DEFINITELY IN PLAY STILL, let’s not forget), and other matters.

As Trudy Lieberman, the reporter who wrote the Nation story, pointed out:

Even with standardized formularies, runaway drug prices could cause Congress ultimately to conclude that Medicare is simply too expensive--and transform it into a means-tested welfare program that would make doctor, hospital and drug benefits available only to the very poorest seniors. That would end Medicare as we know it. Maybe that was the real goal of Part D all along.

That’s why we have to change Medicare Part D to the point where enrollees participate in a single plan administered by the federal government, as stated in the NC Times story.

And we also have to get rid of the bunch of bought-and-paid-for Repug crooks running Congress to make that happen, because no change to this mess will take place while they remain in power.

Finally, as long as we're talking about buying drugs cheaply, I can think of no other organization I can recommend more highly than these good folks.