No, the proposed Medicare "reform" is not better than nothing. The fact is, our representatives in Congress, mostly Republicans, but aided and abetted by Sens. Max Baucus of Montana and John B. Breaux of Louisiana, nominally Democrats, have put together a trap for the foolish. The goal is simple: Under the guise of offering a prescription drug benefit as part of Medicare, throw money at insurance companies and drug companies, and while you're at it, privatize the most successful program since Social Security. The congressional Republicans have an impressive record of convincing people to vote against their own self interest, and it appears they're about to do it again.
In this case, they're using one of the oldest tricks in the medical researcher's armamentarium: Set up the study to get exactly the results you want, then announce the results without discussing the methods. In medical studies it's easy. You compare a drug that needs three doses a day with a new one that requires only one dose a day, but give them both only once a day. The hardest part is to keep a straight face when you announce that the new drug works better than the older treatment. Congress has learned from the drug companies, and is showing off its talents.
Medicare has been a very successful program, but unfortunately, it hasn't kept up with changes in health care. When the program was first designed, hospital costs were the most expensive part of most health care, while out-patient medications were simply an annoyance. Over time, drug therapy has become more effective and more expensive, while hospitalization has been largely replaced by home care. For many Medicare recipients, the cost of drugs is ruinous, to the point where it's a matter of choice whether to take prescribed medication or eat. Some elderly people take half doses of their medication in order to reduce the cost; others live on pet foods in order to save the money needed for medication. A prescription drug benefit as part of Medicare is badly needed.
To congressional Republicans, this is an opportunity, not to help millions of people in need, but to sell out Medicare to the insurance companies. Tacked into the prescription drug bill are provisions to pay the commercial insurance companies to offer their own plans. There will be trials in selected urban areas to compare the costs of traditional Medicare against the commercial insurers, and recommendations for changes to the Medicare program will be based on the results of these trials.
For practical purposes, this test has already been performed. The Medicare+Choice program was designed to induce private insurers to offer health policies to Medicare beneficiaries. The government paid the insurance companies a bonus for offering these policies, but even though the Medicare+Choice plans offered some benefits that weren't available through traditional Medicare, relatively few people enrolled. Those who did enroll often found that they had higher out-of-pocket costs than they had under traditional Medicare. They were forced to use network physicians, and couldn't count on their insurer staying around from one year to the next, since the private companies were quick to pull out of areas where they weren't making adequate profits. According to a report from the Kaiser Family Foundation, between 1999 and 2001 nearly half of the insurance companies offering Medicare+Choice withdrew from either the program, or selected geographic areas, leaving 1.6 million with interruptions in coverage.
The track record of insurance companies has been so poor that Congress had to stack the deck, and they did. According to the rules they're prepared to set, traditional Medicare must buy all the drugs for its prescription benefit plan at full list price. It may not negotiate with suppliers for better prices, may not place limits on the drugs used. It's like going to a supermarket and not taking coupons. Meanwhile, the insurance companies are free to use every cost cutting device known. If, at the end of the trial period, it turns out that the private insurers cost less than traditional Medicare, what will have been proven? Mostly that a Republican Congress knows how to set things up to get the results they wanted in the first place.
When the trial period is over, there will be a report showing that the private insurers were able to provide prescription coverage at a lower price than the government program, leading to the conclusion that privatization of Medicare will save money. The detail about traditional Medicare being barred from even the most basic cost containment methods will be tucked into a footnote, or completely forgotten. The results will prove the advantages of private health insurance and Medicare will be tossed to the wolves.
All politicians stretch the truth, and some do it like a mezzo-soprano in bicycle shorts, but the idea of setting up a deception years in advance is an advance in the technique. It's a sure bet that the Prescription Plan will be passed &endash;- no one can explain the problems with this bill in a five-second sound bite. But it contains a time bomb that, if neglected, could destroy Medicare.
Sam Uretsky is a pharmacist living on Long Island, N.Y.