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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 expensive.

$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.  Sort of. 

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 go.

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 industry.

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.


© Copyright 2003 All rights reserved by Lin Osborn



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