Sam Uretsky

Full Steam Ahead!

It's not true that you can't make this stuff up -- it's just that nobody this side of Lewis Carroll or the Three Stooges would have the ability. Oh yes, one other person: Edward John Smith, the Captain of the Titanic.

On Feb. 8, the White House released figures indicating that the Medicare Drug Benefit would cost $1.2 trillion over 10 years. The administration had originally told Congress that the program would cost $400 billion, and threatened to fire Richard Foster, the chief actuary of Medicare, if he released figures that showed a total cost of $600 billion.

The issue isn't the absolute cost of the program -- that might be excused if that's what the program really had to cost, and somebody, somewhere, had given thoughts to where the money was going to come from besides selling Savings Bonds to China. What is, or should be the issue, is that Medicare Part D is both wasteful and incredibly inefficient. The pharmaceutical manufacturers got what they wanted, the insurance companies got what they wanted, and as for the so-called beneficiaries? According to CNN, 54% of voters over the age of 60 voted for Bush, so evidently they got what they deserved.

It would have been fairly easy to design a good drug benefit plan that would provide elderly people with affordable prescription drugs, using a system that they could understand, while assuring the pharmaceutical manufacturers a fair profit. Members of Congress could have benefitted by having junkets to just about any developed nation in the world to see how it's done. Instead, we were treated to a round of arm twisting that would have made professional wrestling proud. Captain Smith went down with the ship. It's not clear whether the members of Congress that supported Medicare D will show equal contrition.

But, even as the elderly are faced with confusion and, in many cases, higher drug costs, President Bush has been busy promoting his next disaster: Healthcare Savings Accounts. HSAs would encourage people to buy high deductible insurance and would offer tax deductions for money placed in a savings account to be used for health care expenses. In theory, people would shop around for the least expensive care, since they would have to dip into the savings account to pay the deductible. In practice, too few people would have the money to fully fund the savings accounts, and as usual, the tax provisions of the system would favor the wealthy.

Speaking in the lobby of the headquarters of Wendy's fast food chain, our president said of critics of the plan, "It's kind of basically saying, if you're not making a lot of money you can't make decisions for yourself. That's kind of a Washington attitude, isn't it -- we'll decide for you, you can't figure it out yourself. I think a lot of folks here at Wendy's would argue that point of view is just simply backwards and not true."

This was, of course, Wendy's headquarters, where John Schuessler, Chairman and CEO, had a compensation package of $3,945,000 in 2002. The people making $15,000 a year in a Wendy's franchise might have more trouble with a $1,050 deductible, or accumulating $5,000 in the savings account.

And, of course, nobody ever said anything like that. Ever. What has been said, repeatedly, is that HSAs would benefit the healthy and wealthy, and might destroy the poor. Those people living paycheck to paycheck could never fund the savings account, and would have to put a trip to an emergency room on a credit card. Under the creatively named Bankruptcy Abuse Prevention and Consumer Protection Act of 2005, they could never get out from under this debt load.

Healthcare Savings Accounts are unlikely to produce consumer pressures that will lower healthcare costs, since the patient is ill-equipped to make cost/effectiveness decisions and will simply defer to the physician. (When patients tried to make those decisions, by reimporting drugs from Canada, the administration opposed them.) Rather, people will postpone medical visits, fail to fill prescriptions and be faced with debt that even bankruptcy won't clear. If people die for want of affordable care, the president's latest budget would take away a $255 lump-sum death benefit that has been part of Social Security for more than 50 years.

We only have to look at what this administration has done for the health of people over 65 to think of what it can do for the rest of us.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

From The Progressive Populist, April 1, 2006

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