January 19, 2006
-- by Gary Boatwright
One recent afternoon in Los Alamitos, I watched Marcy Zwelling-Aamot, M.D., pick her way through a government website designed to help elderly patients select the right Medicare drug plan, based on their prescription needs and hometown.
The website, created for the launch of Medicare's new prescription drug benefit, identified 48 individual plans available for Southern California residents. All were sponsored by private health insurance companies administering the government drug benefit for a profit. The plans' monthly premiums ranged from $5.41 to $66.08; their lists of covered drugs differed from one another, sometimes significantly; and all imposed different annual out-of-pocket costs on enrollees — a critical consideration for patients on fixed incomes.
A marginally useful website that is hiding in plain site:
Why are people holding off?
Even the government acknowledges that selecting a plan is dauntingly confusing for those without access to its Internet help site. That's a big hurdle, because an estimated 70% of Americans over 65 have never been online.
Big oops? Or intended to boost profits for Big Pharma?
The toll-free information lines set up by Medicare and various health plans have been overwhelmed for weeks. Medicare regulations discourage physicians, pharmacists and healthcare advocates from helping patients select a specific plan. Yet many professionals say they themselves are so confounded by the program's intricacies that their patients will be hard pressed to make the right choices on their own.
The health plans have filled the vacuum with glossy marketing brochures, some of which are flagrantly misleading. "You're pitting big corporations against the most vulnerable people in society, and you're telling them that they can't turn to the people they trust for advice," observes Thomas R. Clark, director of policy and advocacy for the American Society of Consultant Pharmacists, an organization of pharmacists specializing in geriatric and long-term care.
Isn’t that special? Hiltzig reminds us that Bush’s Medicare Prescription Drug Plan is a red headed step child of blatant and intentional fraud:
Its worth remembering that the prescription drug program was born in an act of fraud. The Bush administration sold it to Congress in 2003 by estimating its cost at less than $400 billion over 10 years. Scarcely a month after its enactment, the White House issued a new estimate: $535 billion. That figure might well have killed the bill, which had passed the House by a razor-thin margin even with the lower price tag.
It soon came to light that Richard Foster, Medicare's chief actuary, had known of the higher estimate — but had been told he'd be fired if he warned Congress before the vote. (The current estimate is $700 billion.)
As written, the legislation complied with a drug industry demand that Medicare be prohibited from negotiating with manufacturers for lower drug prices. Among those helping the industry make its stand was Rep. Billy Tauzin (R-Louisiana), whose committee on energy and commerce oversaw Medicare. In an odoriferous development, Tauzin soon quit Congress to become president of the Pharmaceutical Research and Manufacturers of America — Big Pharma's Washington lobbying group.
The program's implementation, meanwhile, was handed over to commercial health insurance companies, subject to indifferent oversight. That explains the perverse variations in monthly premiums, drug prices, even approved drugs, which will make it all but impossible for consumers to be sure they've selected the right plan.
Here’s a kicker from Kevin Drum over at Political Animal, The Prescription Drug Debacle .... Part 341:
It'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.
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.
Very familiar. It's on the tip of my tongue. Help me out here.
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