Drug Benefit's Impact Detailed.....Many Will Face Big Out-of-Pocket Costs

[cthrumatrix]

Drug Benefit's Impact Detailed
Many Will Face Big Out-of-Pocket Costs
By Edward Walsh and Bill Brubaker
Washington Post Staff Writers
Wednesday, November 26, 2003; Page A10


The Medicare prescription drug benefit approved yesterday by the Senate will provide the most help to low-income older Americans who are not so destitute that they qualify for Medicaid, the health care program for the poor, according to experts in the field.

The vast majority of Medicare recipients should receive some benefits from the program when it takes effect in 2006. But the size of the benefits will vary depending on each person's annual spending for prescription drugs, and in many cases will involve substantial out-of-pocket expenses.

For those joining the voluntary plan, prescription drug coverage will not be provided by the government but by private companies. The bill's first impact will come this spring when prescription drug discount cards are issued. The cards, which could be offered by as many as 20 competing companies that charge different annual fees and different prices for the same medications, will be the main benefit of the legislation until the full program takes effect in 2006.

more

Under the plan, most Medicare recipients would pay as much as $1,170 a year in premiums and out-of-pocket expenses. In return, they would receive as much as $1,500 in drug subsidies.

http://www.washingtonpost.com/wp-dyn/articles/A14673-2003Nov25.html


hmmm.... so this eqautes to a 22% discount. Seems to me that people are getting larger discounts than this by buying drugs by themselves through CANADA .....and it does not cost the US Taxpayer a penny.

[cthrumatrix]

1. And how about this "discount card" we hear about .....?

When the drug discount cards become available this spring, the nation's 40 million elderly and disabled Medicare enrollees will have to sort out which cards offer the best savings for their medications. Medicare will provide help on its Web site and toll-free phone lines.

The new cards will compete for business against nongovernment discount programs and with Internet pharmacies in the United States and abroad that may offer lower prices with no annual fees, health benefit experts said.

"For most seniors, they are not going to see this Medicare drug discount card as a big advantage," said Debbie Martin, a principal at Mercer Human Resource Consulting, which has advised private firms on discount card programs. "You may be able to get as good a price just by being a smart shopper without joining any plan."


http://www.washingtonpost.com/wp-dyn/articles/A14673-2003Nov25.html

[radfringe]

2. "Will foster competition and cost less...."

or so says a co-worker of mine that is nearing retirement age...

my response - "When was the last time you benefited from a Republican backed bill that supposedly 'fostered competition' and resulted in lower costs to you? the only ones that benefit from this kind of legislation are the exec's at the top of the ladder - and then a few months later you find out they have been cooking the books to get themselves more benefits and bigger bonuses....."

No response from the co-worker, but I could see a very dim lightbulb flickering over his head... maybe I gave him something else to consider

[girl gone mad]

4. ask him how..

cable deregulation, which was supposed to increase competition and result in lower prices for consumers turned out. (price increases of 40% accrosss the boaard this year)

[ozymandius]

7. Exactly!

This gift to the pharmaceutical companies does nothing to address the cost of medicines. The drug companies receive a federal subsidy for R&D. Now they will receive another subsidy for selling their products. So they can charge whatever the market will bear at the expense of the taxpayer. We all pay, nonetheless.

[saigon68]

9. a very dim lightbulb flickering over his head

LOL:

We call these voters

DIM BULBs around here.

ie: Let's kick ass in Irque, they got nukleer Weapens there !!!!!

[Don_G]

3. Another Problem

A provision in the bill is that Medicare cannot negoiate with the Drug Industry to get volume discounts. Industry will set the prices for the drugs and will get paid what they ask.

[R Hickey]

5. More stalling, smoke and mirrors instead of reform

I wonder if the bill also contains fine print prohibiting seniors from buying their drugs in Canada?

[cthrumatrix]

6. i believe it does mention prohibiting the importation of drugs

[stewert]

8. Bingo...........

If they just let them buy their drugs from canada over the internet they would save way
more than 20 percent.

A senior who needs $3,000 a year for their drugs will get screwed. They pay a $450
premium, and a $250 deductible. That is $700, then they are not covered from $2,200 to
that $3,000. That is another $800 on top of the $700 they already pay.

What kind of deal is that ?

[recidivist]

18. It would depend on what they're paying now.

Your hypothetical senior probably already has medigap insurance. (Most seniors do.) What are his premiums, deductibles, and copays under his current coverage? You can't evaluate whether he will be better or worse off with BushCare unless you know what he is paying now.

The much-discussed low income seniors who currently lack prescription drug coverage -- fortunately, a relatively small minority of the total senior population -- are certainly better off. If helping the vulnerable uninsured is truly our object, this bill is an incremental step in the right direction. It can be amended as we go along, but it DOES establish a baseline entitlement where none existed before.

However, the ink isn't even dry on the new system and you seem already to have internalized the idea that drugs should be free. They aren't. As I discuss below, seniors as a group are relatively affluent. First dollar coverage for seniors amounts to a regressive subsidy.

Of course, if the object of the game is simply pandering and vote buying, none of that matters.

[Dirty Hippie]

10. I researched the savings for a senior

I know. She was taking 5 fairly common drugs and she was able to save about 60% by buying from Canada. As an elderly preson on a fixed income the savings allowed her to buy groceries for a couple of weeks.

[recidivist]

11. There is nothing wrong with deductibles, co-pays, and means testing.

I am not a great advocate of the just-enacted Medicare prescription drug bill. Had it been up to me, a lot of things would have been done differently. This bill WILL, however, cover the currently uninsured and provide coverage for those folks -- fortunately a relatively small percentage of seniors -- who incur extremely heavy drug costs. The drug bill is, therefore, a step forward in at least these two particulars. It will certainly be amended over time to work out problems.

Most of the discussion now is about fairly marginal adjustments for seniors already in relatively comfortable situations. The vast majority of seniors, for example, already have prescription drug coverage, some through their former employers and most through medigap insurance. Will out-of-pocket expenses for most seniors under the new system be higher or lower than their current medigap insurance premiums, copays, and deductibles? I don't know; it probably will vary a lot depending on individual circumstances. This is what happens when we commit to a centralized, one-size-fits all system. It will fit some people better than others. The fundamental mistake lies in taking away the ability to choose.

My biggest gripe with the whole debate on Medicare and prescription drugs, however, is the casual assumption that seniors need to be subsidized at all. The fact is, most of them are perfectly capable of paying for their own health insurance, and should do so. As a group, seniors are affluent. There are exceptions, certainly, BUT MOST SENIORS ARE NOT POOR. In fact, in terms of per capita disposable income, seniors are the second most affluent demographic group in America today. The new entitlement is a REGRESSIVE subsidy. That's R-E-G-R-E-S-S-I-V-E, as in taxing the relatively poor to buy the votes of the relatively rich. Is anybody paying attention? Or is it just too tempting to pander?

By all means, low income seniors -- like low income people of all ages and conditions -- should be helped. The easiest way to do this would have been a graduated scale for buying into Medicaid. But affluent seniors, most of them with their homes paid off, their kids grown and gone, and mostly healthy, can afford to buy their own pills. (Or more precisly, pay for their own medigap insurance, as most of them are doing right now.) Again, let's help people who need help. But we shouldn't be taxing the single mom struggling to raise her kids on a lower middle class income to buy votes from retirees who are vastly better off than she is.

[KAZ]

20. Bravo Recidivist. Couldn't have said it better. n/t

n/t

[LeftHander]

12. Double digit inflation of Rx Drugs

By 2006 that 22% will be absorbed by price hikes by big pharma.

All in all this measure sucks. Noone new what was in the bill iuntil after it was signed. Typical big money lobby.

Repuklickcans say Medicare bargining is the same as price controls.

Price controls are bad because it doesn't just hand big pharma large handout from the good old boys in congress. You pay for my re-election I hand you some taxpayer funds...

We'll hear over and over again...."this dem did'nt want seniors to get rx drug relief" When it comes down to it over one third of the money orginally slated for senior drug benefits went right into the hands of big heathcare. "to help them help seniors" what bullshit It is free operating funds.

Republicans have to get off the idea that handing large amounts of money to corporations is going to actually do anything other than make corporations more wealthy and more powerful. What it comes down to is providing a token Rx plan to go into an election year with that really does very little for helping anyone who pays through the nose for prescription drugs.

[underpants]

17. I loved how ABC closed their report last night "Won't take effect until...

2006"

That little factoid got some mention in the debates (the coverage of them) and some in analysis/explanation but I am sure many seniors found it a bit surprising AFTER it had been voted on.

[Beetwasher]

13. COLLUSION

Whow here really believes the drug companies are gonna duke it out and offer lower prices to get customers? Give me a break.

[Snellius]

14. These are the real numbers and they're shocking:

Sorry for double posting this but I couldn't believe this. These are the projected estimates by the Congressionl Budget Office:

The worst aspect of the new Medicare bill is not just its waste and giveaways but the dishonest way it was rushed and rammed past public scrutiny before anyone really noticed, let alone understood, what was really going down. Now the real numbers start to appear. Before passage, news reports, even the NY Times, stated the annual premiums at about $35 a month, deductible at $250, and with a "donut hole", the coverage gap where expenses are not reimbursed, of $1350 (from $2250 to $3600). Look now at the same figures after 7 years, in 2013, just when the onslaught of baby boomers begins to hit. (The most important change is the upper catastropic limit of the hole from $3600 to $5100. This seems to have been blatantly misreported but I'm still not sure by whom or how.)

..........................2006..........2013
Annual Premium:.....$420.........$696
Deductible:...........$250.........$445
"Donut Hole":.........$2850..... $5066

Source: Congressional Budget Office

And these figures do not include inflation and the inevitable increase in prices of an unregulated monopoly of a vital necessity like drugs.

[underpants]

19. Ouch! Seniors are a super aware lot who know how to count pennies too

Not just the poor one's but like my stepfather who knows every deal at every grocery store and will drive all over town to get them they are going to sit down and boil down these numbers and this victory might not be so great after all.

Great pick up Snellius.

I don't mean to only mention the political ramifications (though wasn't it odd that that is all the Repubes wanted to talk about yesterday) but that a fantastic chance to truly update the system was sold to the highest bidder.

[realFedUp]

15. My Congressman's explanation for voting No on this

A good thing he did too...(mods, this is an e-mail sent
by his office..no copyright infractions)

SCHIFF VOTES AGAINST PRIVATIZING MEDICARE

Since 1965, when Medicare was enacted, extending health coverage to almost every American aged 65 or older, our nation's seniors have benefited from a reasonably comprehensive health benefits plan, covering inpatient hospital services, post-hospital skilled nursing facility services, home health care, hospice care, physicians services, outpatient hospital services and laboratory services, with one glaring exception – the lack of a prescription drug benefit. As Medicare braces for a dramatic increase in beneficiaries and as medicine and science continue to evolve, it is apparent that Medicare must be reformed to better meet the needs of current and future beneficiaries.

This week, the House considered the final version of the Medicare Prescription Drug and Modernization Act of 2003 (H.R. 1). This bill, supported by the Republican Leadership in Congress, fails to adequately and appropriately address the challenges facing Medicare and in fact, jeopardizes the future of the Medicare program.

H.R. 1 forces Medicare beneficiaries to go outside the current Medicare program to private health plans in order to obtain a prescription drug benefit and eventually will force Medicare beneficiaries out of traditional Medicare and into Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO). H.R. 1, in effect, will privatize Medicare.

Under this bill, 2 to 3 million seniors could lose their current retiree prescription drug coverage; 6 million of the poorest Medicare beneficiaries could end up with less drug coverage than they have now; and up to 10 million seniors could see their Medicare premiums rise if they refuse to join an HMO.

Specifically, this legislation:

Coerces seniors into HMOs. The proposed plan would grossly overpay private HMOs and PPOs and includes a $12 billion slush fund to bribe plans to participate, creating a two-tiered Medicare system. Better benefits and lower premiums would only be available through private plans – not an option for a lot of seniors. Worse, it asks all seniors to pay for this private system, even though some won’t have access to it.

Contains a Large Coverage Gap. The proposed drug benefit contains a $2800 gap in coverage that will leave half of seniors without drug coverage for part of the year.

Undermines retiree coverage for millions of seniors. Millions of seniors who have good drug coverage now through their retiree health plan could lose it under the proposed plan. By discriminating against seniors with retiree health coverage, the plan provides incentives for employers to drop existing coverage.

Forces 6 million seniors to pay more for medicine. The plan prohibits Medicaid from filling in the gaps in the new Medicare drug benefit, as Medicaid does now. Given the ongoing state budget crises, up to 6 million low-income seniors and people with disabilities could receive less help with their prescription drug costs than they do now.

Provides a Weak Prescription Drug Benefit and Keeps Prices High. The proposed plan bows to drug industry pressure and specifically prohibits Medicare from negotiating better prices. It also includes watered down policies on access to generic drugs and prescription drug re-importation, allowing drug company profits to skyrocket at the expense of patients.

This plan is unacceptable and I voted against both the House draft and final version of H.R. 1. The alternative which I supported, the Medicare Prescription Drug Benefit and Discount Act of 2003 (H.R. 1199), would have added a new "Part D" to the Medicare program with voluntary prescription drug coverage for all Medicare beneficiaries. Participating seniors would pay a set $25 per month premium and a $100 per year deductible for Medicare to cover 80% of all drug costs up to $2,000 a year. Once a senior reached the $2,000 out-of-pocket limit, Medicare would then cover 100% of all drug costs after that point. A senior with $4,000 in annual drug costs would pay $1,180 -- a savings of 71%. Every drug would be covered under this proposal. The Secretary of Health and Human Services would also have the authority to use the cumulative bargaining power of Medicare's 40 million beneficiaries to negotiate with pharmaceutical
companies for lower drug prices.

When we began debate on this bill in the summer, we were working to add a prescription drug benefit to Medicare. Now we are fighting to save the entire Medicare system as we know it. Many organizations oppose this bill, including: The National Committee to Preserve Social Security and Medicare, the AFL-CIO, American Federation of Teachers, Center for Medicare Advocacy, Alliance for Retired Americans, Medicare Rights Center and Center for Medicare Advocacy.

This Medicare prescription drug legislation is designed to help the drug industry, HMOs, and the insurance industry – not seniors and people with disabilities. For these reasons, I could not support the Medicare Prescription Drug and Modernization Act of 2003 in its current form. I will continue to work in Congress to save Medicare and for a prescription drug benefit that is affordable; with guaranteed benefits; within Medicare; and available to all seniors.

[salin]

16. I still have questions about the bill

1) Does one HAVE to enroll in a program with a private carrier to participate (get the "savings")?

2) Do those private carriers have the ability to turn away potential customers (eg can they cherry pick the healthiest 'customers' who would likely need no or few medications, and deny already sick 'customers' - or pull the 'previous condition' language that would deny coverage for medications for which customers already were receiving - and only cover 'new' medications fo 'new' ailments/illnesses?

3) If one is turned away from private carriers (to expensive of a patient) who provides the coverage?

I have been off line for the most part for several weeks - and have not had the opportunity to follow the ins and outs of this bill. These issues (based on how many private insurance companies tend to behave) have concerned me - and I do believe that in earlier iterations of the bill, for individuals to participate in the program they were going to be required to go to private "approved" (?) carriers - which always seemed problematic to me.

[Wickerman]

21. Where does the 400$ Billion Go?

Does anyone know of any numbers that support how that $400 BILLION will be spent over the next 10 years? 40B a year could go quite far to creating National Health care, it would seem. Instead, we are draining a huge dollar amount from the Treasury to further complicate the system and add further administrative costs.

I've looked for a detailed cost chart but haven't found anything. Oh well, I guess we can just trust the republican controlled govt to wisely spend our dollars.

:eyes: