[eggplant43]

I can't help but believe that this may be a big reason for many politicians to loose their jobs over the next couple of voting cycles.

[angelize56]

This is one case where I feel the voices of the Democrats should have been listened to! I can't wait to see what seniors find out about this bill in the fine print and to see if it really benefits those of the poorest on Medicare. Take care. angel

[combsdon]

Originally posted by angelize56:
This is one case where I feel the voices of the Democrats should have been listened to! Take care. angel

........... .............

[eggplant43]

Ultimately, this is not about what a Political Party is supporting so much as it is about the influence the affected industries involved here have upon the politicians. It appears at this point that the Insurance, Phamaceutical , HealthCare Delivery/HMO Industries benefit greatly from this bill, while the benefit to seniors is of questionable worth.

[Wino]

We shall see whether it is good or bad (as I'm sure Shrub will sign it).

The government needs to get off the pot re healthcare. IF THEY WERE REALLY for helping people, they would make individual medical insurance cost 100% deductable, along with ALL medical expenses, i.e. drugs, office visits, etc. When I was self-employed, I could only deduct 25% (this may have been increased since then) of the cost of health insurance, while a Corp. could deduct 100%. I pay just under $6,000 annually for a personal plan, even though covered by my employers plan (which I now have to pay a portion with less coverage than in the past) as who knows what the future holds - if I got laid off/fired or whatever, would at least have continuing coverage without having to resort to COBRA. If I had neither, no insurance company in their right mind would sell me insurance AT ANY PRICE.

100% (ala IRA's) vs. the small % that can be ducted now if it exceeds your adjusted gross income. That would be (currently for me) approx. $10K a year right off the top - now that would help.

Both Dems & Rep pay lip service in this matter - frankly, I don't think either party gives a ratsass about anyone, but themselves (or they would have the same plans we do - not their present, no cost to them insurance heaven). I'm just thankful I can afford the cost of insurance - really feel for the ones who cannot.

[eggplant43]

I agree with you. Somehow the Senators and Congressmen/women have cradle to grave health insurance, but don't feel the rest of us need that kind of coverage. Why is that?

[eggplant43]

Medicare's new, expensive prescription






IN the final analysis, U.S. pharmaceutical companies will be better protected than elderly Americans in the overhaul of Medicare passed by Congress.

With the closely held GOP legislation approaching 1,000 pages, it will take time to fully understand all that was included and what the cost will be.

Still, this much is known, as Washington Sen. Patty Murray put it, "The Senate has passed a bill that fundamentally changes the Medicare program while adding a meager 'drug benefit.' "

A bipartisan desire for a prescription drug benefit for the 40 million people on Medicare morphed into a legislative catch-all that tied enough disparate interests together to pass sweeping changes.

An initial impulse is to say that the bloated Medicare bill is better than nothing. That is not clear at all.

The bill costs $400 billion over 10 years, and includes $25 billion in higher payments to rural hospitals and doctors. Other hospitals and doctors facing cuts under current law will receive higher payments or avoid future cuts.

Private employers will receive $70 billion in tax-free subsidies to encourage continued drug coverage for retirees once the Medicare drug plan begins in 2006.

The new drug benefit will be administered by private companies and health plans with $12 billion in subsidies.

In the meantime, Medicare is specifically prohibited from using its buying power to negotiate discounts for bulk drug purchases or create any price structures for reimbursement.

Also, the government cannot have a preferred list of cost-effective drugs or specify a cheaper generic substitute for a costlier name brand. Medicare sets prices with doctors and hospitals but is prevented by law from doing the same thing with prescription medicine.

For two years, 2004 and 2005, Medicare beneficiaries can buy a discount card worth a savings of about 15 percent. Starting in 2006, the Medicare plan will collect a monthly $35 premium and charge a $250 deductible. Then insurance would pay 75 percent of drug costs up to $2,250. Then coverage stops until the retiree pays the next $2,850 out of pocket. Both the premium and gap in coverage are forecast to grow 78 percent in the first seven years of the plan.

Premiums and deductibles would be waived for seniors with incomes up to $12,123, and $6,000 in assets. Other seniors, especially with incomes over $80,000 a year, will find higher premiums.

By 2010, Medicare will compete directly with private plans in six metropolitan areas. If Medicare costs were higher than private plans, Medicare participants would pay more.

The final bill did not directly ban reimporting cheaper drugs from Canada, but requires Department of Health and Human Services approval, which has been refused. Drug companies have a direct stake in being for expanded coverage, and against formularies, price caps and Canadian imports.

Enormous expenses are back-loaded into the new Medicare plan. Nothing about the legislation is straightforward enough to pencil out at the kitchen table.

Each piece could have been handled separately. A clean prescription bill was possible. So was more money for rural hospitals. But taken together, they provided political cover for a fundamental change in the 38-year-old government-run Medicare plan.

Democrats did not get the drug plan they wanted, and many conservative Republicans are simply appalled at the expense: "We are saddling future generations with enormous liabilities," said Sen. Don Nickles, R-Okla.

Narrow approval in the House and reluctant passage in the Senate are tell-tale signs not of triumphant compromise, but deep misgivings about what was accomplished. Only the nation's drug companies are absolutely sure.

[eggplant43]

December 3, 2003

Health Industry Bidding to Hire Medicare Chief

By ROBERT PEAR

WASHINGTON, Dec. 2 — The federal official who runs Medicare and was intimately involved in drafting legislation to overhaul the program is the object of a bidding war among five firms hoping to hire him to advise clients affected by the measure.

Though the official, Thomas A. Scully, is not widely known outside Washington, his exhaustive knowledge of the Medicare program and the intricacies of the legislation, approved by Congress last week, would make him a prize catch for any law firm or private equity firm.

In an interview on Tuesday, Mr. Scully said that his discussions with potential employers complied with federal ethics regulations and that he had seen no reason to recuse himself from work on the legislation. He said he had consulted with the top ethics officer for the Department of Health and Human Services and received a waiver allowing him to continue work on the bill. The department confirmed his account.

Mr. Scully has made no secret of the fact that he has been looking for jobs outside the government for more than six months — even as he spent hundreds of hours in closed sessions with House and Senate negotiators working out countless details of the legislation, which makes the biggest changes in Medicare since creation of the program in 1965.

Experts on the federal ethics law said they could not judge the propriety of Mr. Scully's actions without knowing the terms of the waiver, which have not been made public.

Mr. Scully said Tuesday evening, after several earlier interviews about his job negotiations, that he was submitting a letter of resignation and would step down on Dec. 16. He said he had not decided which of the five jobs to take.

Gail E. Shearer, a health policy analyst at Consumers Union, said Mr. Scully's discussions with prospective employers were troubling. "At a time when there are questions about whether the Medicare legislation serves special interests or consumers, we want to know that our public officials have their minds totally focused on doing what's best for consumers," she said.

For his part, Mr. Scully said, "I'm not the most popular guy in the world, but nobody has ever accused me of being other than honest."

After federal employees resign, they are subject to a permanent ban on "switching sides." They cannot try to influence the government on a "particular matter" in which they were personally and substantially involved. In addition, federal law establishes a one-year "cooling-off period," during which former senior officials are not supposed to lobby at all before the agencies where they worked. But they often give clients informal advice about navigating the federal bureaucracy.

President Bush plans to sign the Medicare bill, a centerpiece of his domestic agenda, on Monday. The bill not only offers drug coverage to all 40 million beneficiaries, but also changes Medicare payments to most health care providers.

Mr. Scully, who served as a White House budget official in the first Bush administration, has run Medicare and Medicaid since May 2001.

In the interview on Tuesday, Mr. Scully said that he tentatively decided last May to leave the government but that he stayed on, at the request of the Bush administration, to work on the Medicare bill.

"I have been talking to a number of law firms and private equity firms," he said. "My hope is to combine work at a Washington law firm and a Wall Street investment firm."

Mr. Scully said that after consulting with the ethics officer he saw no reason to disqualify himself from work on the legislation or on regulations that affected clients of the five firms.

"My job negotiations were not serious enough," he said.

A summary of ethics rules issued by the Department of Health and Human Services says employees who have begun seeking jobs in the private sector must immediately recuse themselves from "any official matter" that involves the prospective employer. This covers legislative initiatives and proposed rules, the document says.

A spokesman for the department said that Mr. Scully's waiver allowed him to work on "matters of general applicability like the Medicare reform bill" while he talked to potential employers.

As administrator of the Centers for Medicare and Medicaid Services, Mr. Scully receives a salary of $134,000 a year. Lawyers and lobbyists said he could easily earn five times that in the private sector because he has extensive knowledge of the Medicare program and can offer clients access to senior administration officials.

In his last job, as president of the Federation of American Hospitals, a trade group for investor-owned hospitals, Mr. Scully made $675,000 a year.

No one has suggested that Mr. Scully took any position in return for a job offer. In some cases, he took positions contrary to those of the lobbyists with whom he was discussing employment. But sometimes their positions coincided.

Mr. Scully said he had been talking with three law firms and two private investment firms. He identified them as follows:

¶Alston & Bird. The firm, based in Atlanta, represents the National Association for Home Care and Johnson & Johnson, among other clients. The Washington office is headed by a college friend of Mr. Scully's and includes Bob Dole, the former Senate Republican leader.

¶Baker, Donelson, Bearman, Caldwell & Berkowitz. The firm represents the Disease Management Association of America, which scored a major victory in the Medicare bill, authorizing payment for services provided by its members to people with chronic illnesses. The firm, which includes Linda H. Daschle, wife of the Senate Democratic leader, has also represented the American Association for Homecare, Amgen and the Federation of American Hospitals.

¶Ropes & Gray. The firm, based in Boston, represents the Pharmaceutical Research and Manufacturers of America, the main lobby for the brand-name drug industry. It focused on changes in drug patent laws, one of the hottest issues in the Medicare bill. It also represents many drug companies including Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Novartis and Pfizer.

¶Welsh, Carson, Anderson & Stowe. A private equity investment firm based in New York, it has invested in many health care businesses. It has a major stake in U.S. Oncology, which manages cancer treatment centers and lobbied for more adequate payments under the Medicare bill.

¶Texas Pacific Group. A private investment partnership, it manages assets worth more than $13 billion. It helped rescue Oxford Health Plans, which suffered severe financial problems while Mr. Scully was a member of Oxford's board.

James C. Duff, managing partner in the Washington office of Baker, Donelson, said: "Our firm would be a perfect fit for Tom because we have built one of the top health care practices in the country. We do both legal and lobbying work. Tom's recent experience at the highest levels of the government makes him very attractive to our firm."

[eggplant43]

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December 7, 2003

New Medicare Bill Bars Extra Insurance for Drugs

By ROBERT PEAR

WASHINGTON, Dec. 6 — Medicare beneficiaries will not be allowed to buy insurance to cover their share of prescription drug costs under the new Medicare bill to be signed on Monday by President Bush, the legislation says.

Millions of Medicare beneficiaries have bought private insurance to fill gaps in Medicare. But a little-noticed provision of the legislation prohibits the sale of any Medigap policy that would help pay drug costs after Jan. 1, 2006, when the new Medicare drug benefit becomes available.

This is one of many surprises awaiting beneficiaries, who will find big gaps in the drug benefit and might want private insurance to plug the holes — just as they buy insurance to supplement Medicare coverage of doctors' services and hospital care.

Congress cited two reasons for banning the sale of Medigap drug policies. Lawmakers wanted to prevent duplication of the new Medicare benefit. They also wanted to be sure that beneficiaries would bear some of the cost. Health economists have long asserted that when beneficiaries are insulated from the costs, they tend to overuse medical services.

Gail E. Shearer, a health policy analyst at Consumers Union, said she had mixed feelings about the prohibition.

"I don't want a return to abuses of 1970's and 80's, when lots of confusing Medigap policies were sold to vulnerable seniors," Ms. Shearer said. But she added: "Many seniors and disabled people will face a huge gap in drug coverage. In a bill that's marketed as providing choice to consumers, comprehensive drug coverage is not really an option. That's a disappointment."

The new drug benefit would be the biggest expansion of Medicare since creation of the program in 1965. But patients would still face substantial costs.

Under the standard Medicare drug benefit, the beneficiary would be responsible for a $250 deductible, 25 percent of drug costs from $251 to $2,250 and all of the next $2,850 in drug costs. Private Medigap policies could not cover any of those costs.

A Medicare drug plan could further limit coverage by establishing a list of preferred medicines known as a formulary. The list must include drugs in each "therapeutic category and class" — antihistamines, antidepressants and cholesterol-lowering agents, for example.

But Medicare would not have to pay anything for drugs left off the list. While patients could appeal a denial of coverage, they could not buy private insurance to cover the costs of such drugs.

Under the standard benefit, a Medicare recipient would pay $3,600 of the first $5,100 of drug costs. After that, Medicare would pay 95 percent of the cost of each prescription. In theory, the bill establishes a limit of $3,600 a year on a person's out-of-pocket costs.

But if a beneficiary bought drugs not listed on the formulary, the bill says, those costs would not be counted toward the $3,600 limit.

Congress began regulating the Medigap market in 1990, as a way to protect consumers, many of whom had bought duplicative policies. The federal government and state insurance commissioners developed 10 standard policies, to replace thousands then on the market.

Three of the 10 Medigap policies cover drugs. Under the legislation, an old policy with drug benefits could be renewed — but only by a person who chose to forgo the new Medicare drug benefit. A person who enrolls in the new program could not buy or renew a Medigap policy to help defray drug costs.

Nearly 12 million retirees have drug coverage and other health benefits from former employers. If those retirees sign up for the Medicare benefit, the employers can help pay the beneficiaries' share of drug costs. But those payments would not count toward the $3,600 limit on out-of-pocket spending.

Under the bill, low-income elderly people eligible for both Medicare and Medicaid, the federal-state program for low-income people, would receive their drugs through Medicare. Medicare drug plans will almost certainly cover fewer drugs than Medicaid now covers, state officials say. But the bill generally prohibits Medicaid programs from supplementing the Medicare drug benefit.

If state officials wanted to supplement the new Medicare drug benefit, they would have to pick up the entire cost of the extra coverage. States would not get the discounts and rebates they now receive from manufacturers under Medicaid.

Dr. Lynn V. Mitchell, the Medicaid director in Oklahoma, said she expected Medicare formularies to be "more restrictive" than the drug coverage policies of state Medicaid programs.

"If patients do not get optimal drug therapy," Dr. Mitchell said, "costs will balloon in other areas. Patients may need more inpatient hospital care."

House and Senate negotiators who worked on the Medicare bill encouraged the National Association of Insurance Commissioners to study the Medigap market, with a view to making major changes.

In a report accompanying the bill, the conference committee said Medigap policies should be revised to provide less upfront coverage and to require beneficiaries to pay more of the initial costs of hospital and physician services.

"Numerous studies have demonstrated that covering deductibles and coinsurance has led to higher Medicare spending because beneficiaries become insensitive to costs," the report said. "Beneficiaries with Medigap consume $1,400 more in Medicare services than beneficiaries without supplemental coverage."

This, it said, "drives up costs for everyone — premiums of Medicare beneficiaries without Medigap coverage and costs to taxpayers."

[eggplant43]

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http://www.latimes.com/news/nationwo...adlines-nation




Sunshine State Foggy on Medicare Reform

By John-Thor Dahlburg

Times Staff Writer

December 7, 2003

COCONUT CREEK, Fla. — In no state do seniors make up a more generous slice of the population than Florida, that balmy retirement destination under the palms. So nowhere should the recent reform of Medicare have deeper, more durable consequences on how people vote.

Once, that is, that Florida's nearly 2.8 million residents age 65 and older figure out exactly what has changed, and how it affects them. "People are bewildered by it; they don't know what's happening to their health plan," said Nana Klein, 85, a retired New York state civil servant who keeps track of senior-related legislation for the AARP chapter in this suburb of Fort Lauderdale.

Depending on who's doing the talking, by presiding over the greatest transformation of Medicare in its 38-year history, President Bush has outfoxed the Democrats and made major inroads in their voter base to reinforce his chances for reelection in 2004, or he has presented America's elderly with a prettily wrapped time bomb that will damage their interests in the long run.

"In essence, this reform stinks," said Frank Kaiser, a 68-year-old Clearwater man who runs Suddenlysenior.com, a Web site devoted to senior issues. "It's the biggest Medicare fraud in history, but most seniors won't realize that until 2006. It has booty for the insurance companies, giveaways for the drug companies. It's got stuff for everybody — except seniors."

Bruce Vogel, an economist at the University of Florida in Gainesville, offered a radically different, and much more favorable, view. "It's an increased Medicare subsidy for seniors," said Vogel, an associate professor in the university's department of health policy and epidemiology. "Most seniors are eventually going to see some benefit."

Complicating forecasts of the law's political fallout is the fact that its centerpiece — the creation of long-sought Medicare prescription drug coverage for America's seniors — won't kick in for two more years, long after election day 2004.

"It could be a problem if Democrats get their message out that this is a poison pill for Medicare," said Jim Kane, a Fort Lauderdale-based pollster. "Public opinion has not really formed on it yet."

Bush barely won Florida in 2000 after a contentious recount, and the state remains key to Republican strategists' plans for victory next year. According to a recent poll conducted for a number of Florida newspapers and published Friday, 53% of the state's voters now approve of the job Bush is doing as president, but just 43% expressed willingness to cast ballots to award him a second term.

Kane said that thanks to Bush's efforts to expand Medicare's benefits to include prescription drugs, the president should see some rise in popularity, in the short run at least, among seniors, who constitute 35% of all of the Floridians registered to vote. But Kane said it was impossible to say how long the upswing would last, or whether it would be followed by a backlash.

"Seniors care about two things: Social Security and health care," said Kane. "They live from hand to mouth, many of them. Their incomes are limited. Their medical bills get higher every year; their prescription drug bill gets higher every year. And if they get upset, that's what they vote on."

U.S. Rep. E. Claw Shaw Jr., a Fort Lauderdale Republican, lauded the changes to Medicare as a clear boon to seniors and to his party. But he has been holding town hall meetings throughout his South Florida district, bringing along charts and handouts, to extinguish what he termed "the fires of misinformation" about the new law.

Many of Shaw's constituents are older people living in condominiums and retirement communities along South Florida's Atlantic Coast, sometimes on modest fixed incomes.

"I've literally seen people at the prescription counter deciding which box of pills to give back," the congressman said. Under the new Medicare law, seniors will be able to purchase a drug discount card starting in 2004 and there will be "some immediate relief," Shaw said.

The lawmaker observed with a chuckle that a Republican president and Republican-controlled Congress agreeing to expand a huge social program that was a keystone of Lyndon B. Johnson's Great Society "is kind of like Nixon opening up China."

"It's really quite astounding, and I think it's really going to be to the president's benefit," said the Florida Republican, who chairs the House subcommittee on Social Security. "The basic reason Democrats didn't go along with it was that it was basically the president's bill."

In stark contrast, Democrat Bill Nelson, Florida's junior senator, said he opposed the law because, after study, he concluded it was not in the best interests of seniors or the continued health of Medicare itself. There may be a period of favorable feelings about the law, he said, but they won't last.

"There will be goodwill for 2004 and 2005, and then when the notices start going out in late 2005 about exactly what the drug benefits are [under the changes to Medicare], you're going to start to hear senior citizens saying, 'You mean I'm paying $3,900 for a $5,000 benefit?' " said Nelson. "

Until actual prescription drug benefits kick in and they can judge the law's effectiveness for themselves, seniors in Florida and throughout the country will be subjected to a cacophony of opinions about how beneficial or harmful the changes to Medicare are.

"At some point, people are going to realize that this was not an earth-shattering reform," predicted David Hedge, professor of political science at the University of Florida. "It put in place a small Medicare prescription provision that will give some, but not a whole lot, of relief to America's elderly."

Ernie Hartless, president of Local 731 of the International Assn. of Machinists in Jacksonville, is one Florida senior who has already made up his mind. He's against the new law, which he said would benefit few working-class."I think it's all political to help the president get reelected," said Hartless, 69. "The sad part is, people won't find out how bad it is until after the election. In the meantime, Bush can wave his flag and say, 'I got you a prescription drug plan.' "





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Copyright 2003 Los Angeles Times

[eggplant43]

Moonlighting Federal Watchdogs

LOS ANGELES, Dec. 8, 2003


Some of the National Institute of Health's top officials have received hundreds of thousands of dollars in consulting fees from drug companies whose products they were responsible for monitoring, the Los Angeles Times reported Sunday.

The newspaper, citing records it said it began gathering five years ago, reported that in some instances officials of the federal institute operated as consultants for companies whose drugs were linked to the deaths of patients taking part in NIH studies.

Dr. Ruth L. Kirschstein, who as deputy director and acting director of the agency since 1993 approved many of the consulting arrangements, told the newspaper she did not believe the public's interest had been compromised.

"I think NIH scientists, NIH directors and all the staff are highly ethical people with enormous integrity," she said. "And I think we do our business in the most remarkable way."

She said she would consider making changes in the consulting arrangements.

"Systems can always be tightened up," Kirschstein told the Times during an interview in October. "And perhaps, based on this, we will do so."

A month after that interview, NIH Director Elias A. Zerhouni told agency leaders he would form a committee to study the appropriateness of employee consulting work.

He told the Times he wants the institute "to manage not just the reality, but the perception of conflict of interest."

Medical ethicists said the consulting arrangements represent a clear conflict of interest.

"If I am a scientist working in an NIH lab and I get a lot of money in consulting fees, then I'm going to want to make sure that the company does very well," said Dr. Arnold S. Relman, former editor of the New England Journal of Medicine.

He said the arrangement also raises concerns about patient safety.

One patient the Times said died was Jamie Ann Jackson, who had been listed as "Subject No. 4" in an NIH study of the treatment of kidney inflammation related to lupus, a disease that attacks the body's immune system.

The cause of death was linked to a complication involving use of a drug made by Schering AG, for which Dr. Stephen I. Katz, the senior NIH official involved in the study, was a paid consultant.

Katz didn't stop the study after Jackson's death or warn doctors outside the agency, which could have threatened the market potential for the drug, the Times said.

Katz said his connection to Schering AG had no influence on his decisions and his work for the company had been approved by top NIH officials.

Katz has been paid between $476,369 and $616,365 in company fees over the past decade, the Times said, citing his income-disclosure reports.

Dr. John I. Gallin, director of the NIH's Clinical Center, the nation's largest site of medical experiments on humans, has received $145,000 to $322,000 in fees and stock proceeds for consulting work done between 1997 and 2002, the newspaper said. In one case, the Times said, he co-wrote an article on the gene-transfer technology done by a company he consulted for.

Several other NIH officials were cited as receiving hundreds of thousands of dollars, including one who received more than $1.4 million. Some of them also were paid by companies involved in the agency's research or whose products were the subjects of NIH studies.

Each of them told the newspaper their consulting work was done with the approval of top institute officials.

Uncovering such payments is difficult, the Times said, because the NIH allows more than 94 percent of its top-paid employees to keep their consulting income confidential.

The NIH has been at the forefront of medical research for decades, leading the government's battles against cancer, AIDS and other diseases. More recently, President Bush pressed the institute, part of the Department of Health and Human Services, into service in the fight against biological terrorism.

[eggplant43]

Lost in the Fine Print: Ten Overlooked Policies That Harm Medicare and Its Beneficiaries

While many features of the Medicare Prescription Drug and Reform Conference Agreement (H.R. 1) have received considerable attention, some important provisions have gone relatively unnoticed. The following is a list of ten issues whose impact has been largely overlooked.

HIDDEN PITFALLS FOR SENIORS AND PEOPLE WITH DISABILITIES

1. Severely Restricts Access to Prescription Drugs

The new law gives private insurers the authority to ration access to drugs funded by Medicare. Insurer-created committees decide what types of drugs to cover, which specific drugs to include on their formularies, and how high to set the beneficiary payment for each drug. It will be difficult and, in some cases, impossible to get drugs that are not included on an insurer’s formulary. These restrictions, rarely seen in today’s private marketplace, mean that seniors who have drug coverage today could have less access to drugs under the plan. Thus, even more beneficiaries will lose under this law than the estimated 2.7 million seniors losing retiree coverage and 6.4 million beneficiaries losing Medicaid help.

2. Denies Beneficiaries Genuine Choice

Beneficiaries will have to choose a drug insurer without knowing exactly what drugs that insurer will cover. Even after they learn what drugs are on the formulary, the insurer can change or remove drugs at any time. While beneficiaries must be given notice, they have no option to change insurers during the year to retain access to the drugs their insurer no longer covers. This is a bait and switch. Moreover, if the law succeeds in expanding HMOs and preferred provider organizations (PPOs), there is no guarantee of any choice for beneficiaries in traditional Medicare. Drug coverage will be available only through whatever private insurer plan comes to their area, no matter how high its premium.

3. Allows Premium Variation Based On Where You Live

Medicare charges all beneficiaries the same Part B premium. The new law allows insurers rather than Medicare to set premiums for drug coverage. Furthermore, it has beneficiaries, not the government, pay for local drug utilization differences. Thus, premiums will be higher in areas with older or sicker seniors.

4. Erodes Assistance Over Time

Most seniors are familiar, and dissatisfied, with the standard drug benefit. The law increases each component of the benefit after 2006 by per-capita drug cost growth – which is roughly three times the rate of inflation used to increase Social Security payments. Thus, in 2013 compared to 2006, the deductible will be $445 (from $250) and the catastrophic limit will be $6,400 in out-of-pocket spending (from $3,600). As such, a growing share of beneficiaries’ income will be spent on Medicare prescription drug costs.

FAILS TO REIN IN PRESCRIPTION DRUG COSTS

5. Adopts Drug Industry-Preferred — and Possibly Owned — Delivery System

The new law rejects the idea of reducing prices through group purchasing, instead adopting an untried system of multiple, stand-alone prescription drug insurers — an approach supported primarily by the drug industry. Moreover, the Senate bill’s provision that would prohibit pharmaceutical industry ownership of the private insurers delivering the drug benefit has been stripped from the final law. This potentially allows manufacturers to help set Medicare prices for their own drugs.

6. Prevents Medicare From Knowing The Prices It Pays for Drugs

The law includes policies that limit insurer disclosure of prices to Medicare and excludes policies that ensure adequate Medicare oversight. Insurers are required to submit only their aggregate discount information and their aggregate claims for reinsurance and risk corridor payments. Missing from the law are provisions that would create strong enforcement tools and allow inspectors general audits to ensure that Medicare and its beneficiaries are not paying inflated drug prices.

7. Omits Reforms To Lower Prescription Drug Costs Beyond Medicare

A House-passed provision allowing limited re-importation of U.S.-made drugs from other countries was dropped from the final law. Additionally, no consideration was given to polices that would reduce excessive direct-to-consumer advertising and go further in improving access to generic drugs.

BIAS TOWARD PRIVATE PLANS EVEN BEFORE 'PREMIUM SUPPORT' KICKS IN

8. Promotes Private Plans At Greater Taxpayer — and Beneficiary — Expense

In the name of competition, the Medicare law increase HMO payment rates immediately. By 2006, rates will be an estimated 25 percent higher than traditional Medicare costs for the same beneficiaries. Additional financial incentives – blended payment rates, risk corridors and a $10 billion “stabilization fund” to promote regional and nationwide private plans like PPOs — begin in 2006. This will exacerbate the current system problems: HMOs and PPOs cost more, selectively serve profitable parts of the country, arbitrarily discontinue coverage, and use premium and benefit changes to attract healthy and avoid sick beneficiaries.

9. Steers Beneficiaries to HMOs and PPOs Through Drug Benefit Design

In addition to its explicit promotion of private plans, the law provides them implicit advantages through its prescription drug benefit. Unlike stand-alone prescription drug insurers, HMOs and PPOs can lower their drug premiums through higher cost sharing for basic Medicare benefits or health system savings that result from adding a drug benefit. Moreover, in areas with HMOs or PPOs, a single stand-alone drug insurer would have a monopoly on coverage for all those in traditional Medicare. With little incentive to keep premiums and prices low, stand-alone drug insurance could be expensive, forcing some to join an HMO and leave their doctor to obtain drug coverage.

SHIFTS COSTS RATHER THAN CONTAINING THEM

10. Increases Medicare Program Spending — Beyond the Drug Benefit

The Congressional Budget Office estimates that gross Medicare spending, not including the drug benefit, will increase by $5 billion over the next decade. This cost is offset by savings from an increase in the Part B deductible and a new income-related Part B premium. Thus, rather than providing true cost containment, the law raises costs and hides this fact by shifting them onto the beneficiaries.

[eggplant43]

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Tuesday, January 13, 2004



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Politicians – read this before self-destructing

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Posted: January 13, 2004
1:00 a.m. Eastern



By David Hackworth



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© 2004 David H. Hackworth

The recycled Pentagon types now merrily selling their "expertise" to the weapon-makers and the rest of the current crop of shakers and takers who make up today's military-industrial-congressional greed machine are as usual sucking up big bucks, while many of our vets continue to get the shaft. Also as usual.

Wesley Clark summed up what's going down in a recent campaign speech: "We've got veterans' hospitals closing; we've got people who have to drive six hours to get a checkup; we've got veterans that are waiting six months to get an appointment ... that's not health care."

If elected, Clark promises to add $2 billion to the vet health-care budget. "We've got to fix the veterans' issues here in America," he said. "We're going to put the full funding we need to get the Veterans Affairs to meet our ... former service members' needs."

Since 1996, the VA's workload has increased from 3 million to 7 million vets without a comparable increase in operating funds. There's presently neither the money nor the infrastructure to take care of all those who paid the hard price when Uncle Sam said, "I want you." Which is why the enrollment of thousands of eligible vets in the category designated as Priority Group 8 – non-service disabled vets and those with incomes higher than $24,000 a year – were dropped like a live grenade last year.

According to VA honcho Anthony Principi, this suspension affects only the lowest-priority group in the VA's eight-tier system – vets in Group 8. But he says Priority 8s already enrolled will be "grandfathered" and allowed to continue in the VA health-care system.

"Who is Principi to play God?" asks Vietnam vet Lawrence Tahler. "When is a vet not a vet, and why should these good men and women be penalized for not getting their paperwork in before some bureaucrat arbitrarily decides to change the system?"

"I'm a Priority 8 Vietnam vet who was denied enrollment," Donald Schlotz says. "As a result, I annually spend over $7,000 on health insurance for promised care that would otherwise be provided by the VA. It looks to me like the Bush administration is trying to save money at the expense of vets who were assured they'd have health care for life."

Millions of vets who agree with Schlotz are angry because they believe the Bush administration has looked the other way when it comes to the aging veteran population.

But Bush's $63.6 billion 2004 VA budget actually comes in at a whopping 7.7 percent increase over last year's allocation – the biggest VA increase in history. The bummer is, that's far from enough dough to do the job.

"This action against Priority 8 vets is outrageous," Schlotz says. "It's particularly distasteful that this now pits vets against each other for benefits, rather than providing benefits for all. Moreover, by 'grandfathering' some vets, it discriminates between similarly situated vets based on nothing other than when they applied for benefits."

The Priority 8s are the victims of a government that's forgotten George Washington's sage warning: "The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the veterans of earlier wars were treated and appreciated by their nation."

While Clark has low-balled the money needed to get the VA program back on track, he's spot on when it comes to the 2004 election. Veterans – and there are millions of them from sea to shining sea – have vowed to hold our politicians' feet to the fire this time around to make sure they honor our nation's sacred obligation to the men and women whose sacrifices have made our country the freest in the world.

Principi recently said, "Our veterans deserve nothing less than the best a grateful nation has to offer."

Sounds good. But Principi, the president and Congress should be told that America's vets need action, not more glowing words. Payback begins at home. Our country's service heroes must be properly looked after before the rest of the world gets any more goodies. And certainly before the powers that be give another thought to colonizing the moon or Mars.




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Col. David H. Hackworth, author of his new best-selling "Steel My Soldiers' Hearts," "Price of Honor" and "About Face," has seen duty or reported as a sailor, soldier and military correspondent in nearly a dozen wars and conflicts – from the end of World War II to the recent fights against international terrorism.

[eggplant43]

U.S. Urged on Universal Health Insurance

Institute of Medicine Recommends Government Provide Universal Health Insurance by 2010

The Associated Press



WASHINGTON Jan. 14 — The Institute of Medicine on Wednesday recommended for the first time that the government provide universal health insurance, attempting to spark an election-year debate on a decades-old problem that keeps getting worse.
The president and Congress should set 2010 as the deadline for providing coverage to all, according to the institute, part of the National Academy of Sciences, a private organization chartered by Congress to provide scientific advice to the government.



The report endorsed no proposal and provided no estimate of cost, except to say it would be expensive.

It said that rising costs, increasing numbers of uninsured and growing financial pressures on health care providers have created the right conditions for major reform at the federal level, a decade after Congress rejected President Clinton's proposed overhaul. The report was the last of six studies over three years that explored aspects of the lack of health insurance.

"I believe we're reaching the point where the system is unsustainable," said one of the report's authors, Dr. Arthur L. Kellermann of the Emory University School of Medicine in Atlanta.

Mary Sue Coleman, president of the University of Michigan and head of the committee that prepared the report, said the problem "is not going away. It will only get worse."

The Census Bureau reported that 43.6 million people lacked health insurance at some point in 2002, compared with 39.8 million in 2000.

The study said that strong, bipartisan support is necessary for any proposal to move forward. The report got a boost former Republican Sen. Bob Dole, who praised the goal of universal coverage but said a partisan effort tied to one approach would be doomed to failure.

"If properly framed, the lack of coverage ... can be one of the big, big issues in this election," said Dole, who attended a news conference on the report.

Separately, a survey by two pollsters, a Republican and a Democrat, for the American Hospital Association found that a majority of Americans, including a majority of Republicans, are willing to pay higher taxes to "assure every American citizen receives health care coverage."

Yet reaction to the study showed the partisan divide that has marked the issue. Democrats were overwhelmingly supportive, while Republicans were skeptical.

Health and Human Services Secretary Tommy Thompson said universal coverage by 2010 is "not realistic."

In a meeting with reporters this week, Thompson said, "I just don't think it's in the cards. I don't think that administratively or that legislatively it's feasible."

The Bush administration last year proposed spending up to $89 billion in health care tax credits to help those who do not have employer-based coverage. The Republican-led Congress took no action.

Thompson said the president would have more to say about the uninsured in next week's State of the Union address.

Senate Majority Leader Bill Frist of Tennessee said he was concerned that the report "may not focus enough on the reasons why health care costs continue to rise and how to pay for any reform."

Senate Democratic leader Tom Daschle of South Dakota said the lack of insurance is the leading domestic issue today. He said the report's goal could be met. "I think it's essential," he said.

The institute said the lack of health insurance was deadly, costly and a cause of insecurity even among the insured. Rejecting incremental expansions, it said only major reform at the federal level would make universal coverage a reality.

In previous reports, the institute has estimated that the lack of health insurance causes 18,000 unnecessary deaths in the United States and costs the nation $65 billion to $130 billion annually.

Layoffs and cutbacks in health benefits by employers have led even those with insurance to worry that they could lose it. Lack of adequate health insurance "creates insecurity for everyone, because losing that coverage tomorrow is so easy," the report said.

The Census Bureau said a decline in workplace-based coverage was the main reason for the increase in uninsured between 2001 and 2002.


On the Net:

Institute of Medicine:

[eggplant43]

Posted on Wed, Feb. 11, 2004



U.S. Report Downplayed Health Problems

MARK SHERMAN

Associated Press

WASHINGTON - Health and Human Services Secretary Tommy Thompson said that his department was wrong to edit a report about health care for minorities to downplay serious problems and emphasize improvements.

Responding to criticism from Democratic lawmakers, Thompson on Tuesday said the report, issued in December, would be released in its original form calling health care disparities pervasive "national problems."

"There was a mistake made and it's going to be rectified," Thompson said at a hearing of the House Ways and Means Committee on the president's 2005 budget proposal.

Democrats protested the changes to Thompson after they obtained the original draft report. The final version eliminated the conclusion that unequal care for minorities is a national problem, the Democrats said in a letter to Thompson.

The word "disparity" was used more than 30 times in the "key findings" section of the draft's executive summary, they said. It appeared just twice in the final version.

The department conducted the study as part of a congressional requirement to review health care treatment provided to women, children, minorities and the poor.

The report found a higher death rate for cancer among blacks and low-income Americans in its review of the nation's health care system. It also said those groups are less likely to be screened for certain cancers and less likely to avail themselves of other preventive services.

Thompson issued a statement upon the report's December release, saying it shows areas in which the nation has improved health care, "but more importantly, it shows us where we have more work to do and how we can make sure that all Americans benefit from scientific advances and technological innovations."

Thompson said he did not rewrite the edited portions, assigning the blame to unnamed officials who "took it upon themselves that felt they were doing the right thing."

The Democrats said political appointees cleared the edited version.

ON THE NET

DHHS reports: http://www.qualitytools.ahrq.gov