This was written after Part D of Medicare was pushed through by the Bush Administration. It fully applies to the report of Obama's deal with Pharma to get the Affordable Health Care bill approved, as described in a N.Y. Times article of June 8, 2012
Politics of Medicare Drug Program
Those of us who participate in internet dialogue are the small proportion of Medicare recipients who have the requisite skills to research and perhaps comment on this program. The average Medicare recipient is in his/her late seventies, with diminished energy and cognitive capacity. And these are the lucky ones who have escaped chronic somatic or neurological illness.
Instead of providing a program that will ensure that these people receive the benefits of drug coverage efficiently, reliably and economically; instead of building a delivery system around the capacity of the elderly, something quite different, and rather reprehensible has occurred. The elderly Medicare recipient has become the objects of marketing that obfuscates and misleads. Respected organizations such as AARP and trusted public figures offer assurances that gloss over the defects and the social damage of this program.
This Medicare Drug law, or Part D, gives every advantage to the insurer and minimal protection to the consumer. Most of us are aware, and incensed, that the insurer can remove a drug from their formulary with 60 days notice, yet the user, who can no longer get this drug that offers the optimum treatment, may not switch his insurer for up to nine months. But what is less known is that notice of the removal of the drug does not even have to be sent to the client, it merely has to be put on the insurerÂ’s web page. How easy would it have been to have required direct notification to the user? But the needs of the users were never central to those who wrote this law.
The increased burden on physicians is an unexamined consequence of Part D. Under this program they will be asked to tailor their prescriptions to the different formularies of various insurers, at the very time that their payment for visits are being reduced by Medicare. And they do not get to bill for their time spent sending requests for exemptions when a drug is not available or discontinued.
Right now there is a growing movement among primary physicians called boutique practice, where they charge an annual retainer of up to several thousand dollars per patient. They still bill Medicare or the private insurer for each visit. The retainer is to get into the door. Dealing with the complexity of Part D will both justify and compel more doctors into this type of practice. It may well result in a two tier system, with the more competent doctors charging an annual fee, and those less skilled treating others who can not afford the retainer.
The supporters of Medicare Part D would like to convince us, and the country, that the grumbling over this program is due to its complexity, that the "“poor dears"” just can'’t quite master such difficult material. When they have it carefully explained to them they will appreciate it.. They would like to convince the country that the doughnut hole will act as a restraint on wasteful spending, as if we really love to take excess drugs and need an impending cutoff of insurance to hold back. They refuse to acknowledge the reality, that when the drugs are no longer reimbursed during the doughnut period many will simply stop taking them, and just get sicker. It is simple to make laws when you ignore realities of the human condition.
Medicare Part D, is predicated on a fantasy, that the sick and elderly will download the daily virus protections, carefully navigate the mine field of phony scams to connect with their insurer on the internet. Mandating this as the exclusive way to monitor continuation of drugs is declaring open season on the elderly for identity theft. And those who complain, watch out! We will be denigrated as wanting socialized medicine, freeloaders who need to have restraint imposed on them.
The administration conveniently wants to impose this restraint by protecting the right of drug companies, their largest contributors, to charge Americans more than any other person in any other country in the world for their products, that are largely developed by basic research that we all pay for. Data is now available showing how costs under this Medicare plan will be much higher than under the VA plan that allows the agency to negotiate with the drug companies. And they will also instill discipline on us by making sure that the insurance companies have absolute discretion to control expenses by cutting off drugs, while we have the right to try to get a doctor to argue with the insurers, on their own time.
For those with low current drug expenses, the sales pitch is protection against catastrophic events, a sickness that requires otherwise unaffordable pharmaceuticals. But even this is illusory. The most expensive drugs are cutting edge, often outside of the mandated categories defined in this program. After years of paying for this insurance there is no certainty or even probability that the most effective life saving drug will be covered. You can hope that the diagnosis comes down during the two months when you can switch insurer, but during the rest of the year you are out of luck.
At what point do we stop trying to decipher this program, comparing one insurer against another using their formularies that they can change at will. When do we realize that the problem is not in our inability to comprehend this plan, but in its intrinsic design.
It is reasonable and right that a limit be put on public funds allocated to the health care of the elderly. We cannot demand that all of the ills that afflict us be treated at any cost. But we have every right to demand a rational program that is accessible to those whose age limits capabilities.
This program that empowers corporations to use every artifice to manipulate the marketing and distribution of life saving products is the logical conclusion of an anti-government, pro-corporate ideology gone mad. It takes the most efficient segment of our medical care establishment and overlays a gratuitous private middleman. And don'’t be fooled, this drug program is not free enterprise; it is a cruel parody of it.
Under Part D, the decision on medication will no longer be between you and your physician, evaluating side effects, cost and efficacy; but will be subject to the vagaries of a private insurer. Their profit, with no limit such as applied to supplementary Medicare insurers, will be the difference between their premiums received and drugs purchased. Their fiduciary duty to their shareholders is to keep the expense of these drugs as low as possible.
Profit maximization for this industry does not come from innovative business models or development of new products, it comes from finding a way to deliver less pharmaceuticals to a very vulnerable population. If the obfuscation and manipulation in the marketing stage is any guideline, the actual delivery of drugs will be a travesty.
This Medicare drug program was passed by the House of Representatives only after the normal half hour vote was extended to three hours, while the Republican leadership threatened and cajoled their party members who were choking on this monstrosity. Input by Democrats, that just may have softened some of the most egregious provisions, were never even considered.
The following is the web site of a study by the Kaiser Foundation that elaborates on the defects of this program:
http://www.kff.org/medicare/upload/Consumer-Protection-Issues-Raised-by-the-Medicare-Prescription-Drug-Improvement-and-Modernization-Act-of-2003.pdf
Read article describing data showing:
Drug Prices in Medicare Plans are 48% Higher Than Veterans' Prices
