Map of life expectancy at birth from Global Education Project.

Tuesday, January 17, 2006

Can these clowns do anything right?

No, but it's mostly because they don't want to. I'm not sure why the Medicare Part D debacle has gotten scant attention in the blogosphere, but I expect it's because of the underlying wonkish complexities of it all. We bloggers are supposed to be snappy and snarky, and this particular mess just doesn't have an attractive surface.

Medicare beneficiaries are showing up at the pharmacy and not getting their prescriptions because of a couple of different categories of screwup, but they all come down to the same basic cause. Instead of just letting the Medicare program pay for people's prescription drugs directly, as it does for their doctor visits, Congress set up the program as a massive subsidy for drug and insurance companies. Benefits have to come through an insurance company, that sets up whatever schedule of deductibles, co-pays and approved drugs it wants to. (That's in addition to the built-in deductibles in the Medicare financing.) Presumably, with the help of a supercomputer and an accurate prognostication of exactly what drugs you are likely to be prescribed in the future, you can choose the plan that provides the coverage you happen to need at the lowest price to you.

From the point of view of the members of Congress, this has two benefits: since hundreds of different insurance companies are actually purchasing the drugs, they have little or no bargaining power with the drug companies and they can't negotiate lower prices. At the same time, they get to make a profit by administering the program. That's all taxpayers' money that's being wasted to line the pockets of two industries that just happen to be major campaign contributors. Oh yeah, the bill was largely written by then-Representative Billy Tauzin, who is today the head of the drug industry lobby.

Not surprisingly, a lot of people have yet to figure it out -- the vast majority of beneficiaries have yet to enroll in Part D at all, while some of those who did evidently chose wrong and found out they couldn't actually get their prescriptions paid for after all.

"Dual eligibles" -- people who receive both Medicare and Medicaid -- are a particularly troubling category of problem. They already had prescription drug coverage under their state Medicaid programs, but the new Medicare benefit is supposed to take over paying for that portion of their drugs that it covers. As far as I know most states attempted to make this switch automatically for their dual eligible populations on January 1 but there were massive screwups. Either people wound up in plans that didn't cover their prescriptions, or they didn't get into the databases at all and pharmacists were unable to verify their coverage, or they wound up in plans with high co-pays that they couldn't afford. This problem is so bad that half the states have pledged to continue paying for drugs under their Medicaid programs until it gets straightened out. If you don't happen to live in one of those state's, you are urged to "contact your regional office of the Centers for Medicare and Medicaid Services." Right. And BTW, if dual eligibles don't enroll in Part D, they can lose their Medicaid benefits entirely.

Which brings us to another dirty little secret: many retiree health plans receive subsidies from Medicare to continue covering people, but if people enroll in Part D, they lose those subsidies and, in turn, the people lose their coverage. Some people, in nursing homes, were enrolled in Part D without their knowledge and will have to disenroll in order to keep their retiree benefits -- or more likely some people will have to do it for them.

Then, once people have used up the first $2,250 in coverage, people will hit the dread doughnut hole, where they will have no coverage at all but will still be paying premiums. Oh, and by the way -- Part D completely excludes any coverage for Barbiturates, Benzodiazepines, or prescription vitamin and mineral products. Why? I dunno, I guess these particular chemicals are anti-Christian or something. Maybe if you can't sleep or you're anxious, or you're malnourished, it's because you don't pray enough. But if you have a seizure disorder, you're out of luck.

And, in the middle of all this godawful mess, the relevant information on the Medicare web site is down. Go ahead -- go there and try clicking on the links that say "Prescription Drug Coverage" and "Want to learn more about prescription drug coverage?" Dead as Clarence Ray Allen.

The bottom line for me? As long as corporations run Congress, they'll never do anything right for us. But they'll do just fine for themselves.

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