Health Care Insecurity Forever
Posted July 9, 2003 thepeoplesvoice.org
By Lin Osborn
What ever comes out of
Congress this session in the way of Medicare reform, you can be sure it
will be confusing, discriminatory, narrowly focused and uniquely
$400 billion has been
designated as the target 10-year cost.
I wish that number were the result of some actuary’s dream
mission to compile critical health care data and accurately forecast
Medicare drug spending in the next decade or so. We should be so lucky.
The total has nothing to
do with reality. The magic
number was arrived at first, then Congress decided how to fashion a
program. The result looks like “nothing in nature,” shifting the
elderly in and out of coverage, then in again as their expenditures rise.
There is no real reasoning behind the $400 billion figure. It’s
not so small as to be laughable, but not so large as to be really helpful.
Here’s an interesting
number: how much do the
actuaries in Washington say it’s going to cover?
27% of what Medicare beneficiaries are expected to spend.
The rest is out of pocket. A
fortunate few can afford that, but many more cannot, so they will resort
to pill splitting, skipped days and foregoing medication.
They will sicken and die faster.
That is the inevitable and unforgiving result.
Bush says this benefit is
modeled after the Federal Employee Health Benefit Plan (FEHBP).
But just saying something doesn’t make it true.
And anyway, what does that reference actually mean?
Is it that FEHBP plans are only five times as “wasteful” as
Medicare, while other managed care plans spend 15 times as much on
overhead that Bush finds so attractive?
Or is it the inequities of geography and pricing?
Rather than trust their
own data, Republicans, “believe” the market place can hold down
medical costs, and so are building them into the plan.
One of the most reliable
ways to hold down costs is to combine the purchasing power of many and get
a volume discount. The
Veterans Administration negotiated with drug companies in 2001 and paid
52% less for a list of 24 medicines than Medicare paid for hospital
provided medication. Better
than going to Canada.
But this administration has been fighting states that want to lower their
costs by aggregating their Medicaid populations and negotiating economies
of scale. Bush’s appointee
to the Center for Medicare and Medicaid Services, Thomas Scully, says he
won’t allow it for Medicare either.
His reasoning is priceless: Medicare,
he says, is too big to demand price concessions.
“If we did it, we wouldn’t be negotiating, we’d be price
fixing.” Has anyone told
him that most countries bargain precisely that way, and pharmaceutical
companies keep selling them drugs anyway?
The US hopes to save
health care dollars by giving control over to industries that administrate
health care. That means
“savings” will come from formularies (nothing is guaranteed), mail
order prescription houses, red tape, and, of course, a variable system of
co-payments, premiums and deductibles.
The 15 years that managed care has been around should be enough to
demonstrate that if stability is a goal, managed care is not the way to
Here is the best part.
Hidden in the fine print are provisions that will help ease seniors
into a privatized system starting in 2010, assuring health care insecurity
forever. Right now the press
is predictably distracted by the confusion of the dueling schemes, and
only policy wonks are talking about imminent privatization.
Congress would rather we focus on these details, anyway, than tell
the baby boomers that by the time they’re ready for Medicare, they’d
better be prepared to buy it; at market rates; preferably with as few
safeguards and mandates as possible. Caveat Emptor.
Both Democrats and
Republicans have bought into the idea that we need to ration health care
and subsidize industry. Decisions
are not based on what will be good for patients, or the elderly, or even
the country as a whole. What
matters here is two things: fattening
corporate bottom lines, and getting re-elected.
Congress will pass something they can call a Medicare Drug Benefit
so it can show up in the election ads in the fall, no small portion of
which will be paid for by pharmaceutical companies and the insurance
If they really wanted a
pharmaceutical benefit our seniors deserve, all they have to do is alter
one little line in Section 1832 of the Social Security Act where “the
scope of benefits” is defined. Just
add “pharmaceuticals as medically necessary.”
That’s all anyone is asking for.
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