Washblog

Why Your Medicare D is So Dang Dumb

[Editor's note] I've attached the latest from HHS at the end of the article - AR

Thinking that congress had your best interests in mind when they legislated the new Medicare Prescription Drug Benefit?

Think again.

I susbscribe to The Nation and take it to work to read during breaks and at lunch. Trudy Lieberman wrote a good explanatory *article about the Medicare D program - a boondogle that has stumbled right out of the gate in its implementation.

To understand why your new Med D prescription benefit is so complicated, confusing and expensive for your budget, you must understand one thing about the economic theory of the elected Republican majority at the national level.

"What's good for corporate capitalism is good for the country."

 They really believe that.

They really believe that economically and socially the wisest plan is for  "pseudo conservative" legislation to force all of us to get out of the way while tax cuts to the rich and loopholes to business make our lives better.

Right ...

Medicare D is modelled on one of our classic corporate capitalist national failures: our commercial health insurance system. That's the vaunted one that under the most powerful economic force in the world has left us in 37th place globally in terms of effective and quality national health care.

That's the vaunted one that any system modeled after Britain or Canda or any other country where EVERYONE is covered would never exceed the vauntedness of corporate America's capitalist dream.

Here's how they did it ... and you must remember the power of lobbying in this country and how senators and congress persons can't decide how to vote until a corporate capitalist prompts their wisdom with cash.

These wise lawmakers chose some 260 private insurers (corporations who supported this scheme with lobby money given primarily to - you guessed it - Republican lawmakers. Republicans, you surely remember, are the majority in congress and therefore have the power to turn the scheme into law). These wise partisan lawmakers have forced you to choose one of those elite insurers.

Who are these chosen 260?

Why they're private pharmacy benefit insurers, HMO's, pharmacy organizations like Walgreen's, Long's and Wal Mart. You surely didn't think they are social-minded or populist organizations like the Grange did you? Naw ... these aren't social minded do-gooders. They're the profit-minded self-interested.

Our economically "wise" lawmakers have now made it legal for our government to send YOUR medicare money - I mean it, the actual money that would be used as your individual medicare benefit - to the corporation you have to pick  from among the 260.

It's an automatic revenue the corporation will spend advertising or marketing costs for in order to out-muscle the competition which will then be passed on to you as part of the additional premiums you'll pay out of pocket for your medicines.

This is a free-market system run amok.

In some areas seniors have 40-50 choices of plans. The plans have confusing choices of options, many of which involve differing monthly premiums (ranging from $0 to $60).

There are combinations of deductibles.

There are combinations of co-insurance (your percentage/their percentage of the medicine's price).

There are options to try cheaper generic drugs.

There are "tiers" (levels of priority and/or allowability) based on copays, generics, preferred brands, non-preferred brands, specialty drugs ...

and whether you buy from an "in-network" pharmacy with discounts or "out-of-network" pharmacy with no discounts.

There is no standardized nomenclature (no set of names, concepts, options and plan definitions that are standard among all of the 260 chosen corporate medical monopolists.) One uses the phrase "co-pay"; another calls it "deductible".

What if we folks have questions?

Well,  we can go on line to a web site with a complicated web answer-giver. If you're one of the 75% of seniors who have never gone on line - well, chin up! A whole new cyber adventure is out there just waiting for you to invest in another corporate hog-trough sector by buying a computer and joining the internet surfer society.

What's going to happen with this pick-your-pocket-because-you're-over-a-barrell scheme?

Remember, the Republicans got this doofus plan passed with a projected price tag of $400 billion - a little less than the current sub-total for war spending in Iraq and Afghanistan by the way.

But wait! We then learned that the Bush Administration told Medicare officials - in the tradition of Bill O'Reilly - to SHUT UP. They were told to keep the real cost which is in excess of $550 billion a secret.

What about the sacred chosen 260? All vendors are not expected to remain "competitive." That means that not all vendors are expected to survive in the free-market system.

No, the biggest sharks with the biggest teeth and the biggest lobby dollars will win the survival of the health insurance fittest. We'll  see the 260 reduced to perhaps 10 survivors; mega-innsurers who will slug it out for all the leavings of those other 250 who just couldn't make it.

And instead of free-market capitalism we'll have closed-market monopoly based on sending Medicare tax dollars to friends of the Republicans.

Who might that be?

Well, United Health Group is spending 75 million on marketing and operations for this new Republican give away.

Aetna= $50 million
Cigna: $40 million
Humana (a midwest regional insurer)= $80 million.
Pfizer's in there too. You know Pfizer ... Bob Dole sold his Viagra perspective for Pfizer.

But those investments are chump change compared to what happens when all the Medicare clients sign on to automatic directed payments to the chosen hog-trough recipient. This is the Republican American Way of course and whatever premium you pay to your chosen insurer will include recovery of that marketing money.

Then there's this: You'll hear words of wisdom from the Medicare RX Education Network and may receive mailings in envelopes bearing a return address of the U.S. Chamber of COmmerce.

You are forgiven if you mistakenly assume these are official government communications to you. They are not.

They have been allowed by Republican free-marketer politicans to use the government's official logos.

And if you run into something called "Medicare Today," you'll be seeing a creation of the Healthcare Leadership Council. Who's that you ask?

Well, a group of hospitals, drug companies, medical equipment makers and academic medicate centers joined up some 300 members. They then raised millions of dollars for "outreach" to get seniors to sign up and authorize one of them to receive government Medicare dollars earmarked in your name.

The 37th best medical care system in the world is 37th because that system functions in the tradition of Exxon-Mobil's double-digit billions of dollars quarterly profits. However, the 37th best medical care system is #1 in what is the truest priority: Turning billion-dollar profits while at the same time failing to adequately treat and protect all of its citizens.

That's the linkage between corporate lobbyists and corrupt politicians. That linkage and system is more and more revealing itself as foundational to the failed economic politics of contemporary corporate conservative Republicanism.

*Reference: The Nation, January 30, 2005 - KILLING MEDICARE by Trudy Lieberman who writes about healthcare for The Nation.

Update [2006-2-18 16:10:46 by Arthur Ruger]: The latest update on how Medicare D is unfolding and rolling out can be seen as a short PDF FILE created by HHS secretary Leavitt's office.

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