Medicare -- A Journey Through the Swamp

I took my first tentative steps in trying to figure out the Medicare Part D Prescription Drug Program (PDP) in the last three weeks and I'm no wiser than when I started. Yes, I found an attractive plan, but no, it doesn't cover the drug I am not getting currently but have been advised by the rheumatologist that I need (list price $1,037 for 6 shots). The same drug is obtainable from Canada for $635. This therapy is reputed to have dramatic results in the treatment of rheumatoid arthritis. The therapy may continue for as long as six months.

My choices then become paying a higher monthly premium and having that amount deducted from my social security check or waiting until the rheumo gets so bad my hands don't function at all or a) hold off till Congress fixes something or resigning myself to seeing my savings, on which I depend, wiped out.

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Real People Really Helped by the Patient's Bill of Rights

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If you tuned into the <a href="http://rachel.msnbc.com">Rachel Maddow Show</a> last night, you know that major health care provisions in the <a href="http://www.healthcare.gov">Patient’s Bill of Rights</a> take effect today. You also know Gail, the woman in <a href="http://www.whitehouse.gov/healthreform">this video</a>. She’s an amazing person whose life was immensely improved because President Obama and the Democratic Majority in this Congress fought tooth and nail for health care reform that puts patients first.

Gail was told by her doctor, “Either you dip into your retirement fund, or you’re going to die.” Because of health care reform, she can now choose to live and keep her retirement. Gail, previously denied coverage because she has a pre-existing condition, was able to enroll in a temporary high-risk pool to receive the cancer treatment she needs and deserves because of the Patient’s Bill of Rights. By 2014, no insurance company in the nation will be allowed to deny her care.

Gail is one of millions of Americans who know firsthand that the need for health care reform was and continues to be a life and death priority.

I recently met Violet, a gregarious two-year old girl born at Contra Costa County Regional Medical Center near my district. She was born with a rare – and costly – form of epilepsy. Under the old system, she was at risk of reaching her plan’s lifetime and annual coverage limits by the age of four, and there was little stopping her insurance company from finding trivial excuses to kick her off her coverage. As of today, the Patient’s Bill of Rights guarantees that lifetime coverage limits and rescissions are banned in all new plans, and annual limits are being stretched over a three-year flexible period until they are completely eliminated by 2014. 

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Real People Really Helped by the Patient's Bill of Rights

If you tuned into the Rachel Maddow Show last night, you know that major health care provisions in the Patient’s Bill of Rights take effect today. You also know Gail, the woman in this video. She’s an amazing person whose life was immensely improved because President Obama and the Democratic Majority in this Congress fought tooth and nail for health care reform that puts patients first.

Gail was told by her doctor, “Either you dip into your retirement fund, or you’re going to die.” Because of health care reform, she can now choose to live and keep her retirement. Gail, previously denied coverage because she has a pre-existing condition, was able to enroll in a temporary high-risk pool to receive the cancer treatment she needs and deserves because of the Patient’s Bill of Rights. By 2014, no insurance company in the nation will be allowed to deny her care.

Gail is one of millions of Americans who know firsthand that the need for health care reform was and continues to be a life and death priority.

I recently met Violet, a gregarious two-year old girl born at Contra Costa County Regional Medical Center near my district. She was born with a rare – and costly – form of epilepsy. Under the old system, she was at risk of reaching her plan’s lifetime and annual coverage limits by the age of four, and there was little stopping her insurance company from finding trivial excuses to kick her off her coverage. As of today, the Patient’s Bill of Rights guarantees that lifetime coverage limits and rescissions are banned in all new plans, and annual limits are being stretched over a three-year flexible period until they are completely eliminated by 2014.

At an assisted living home in Livermore, a city in my district, I met many residents at risk of entering the Medicare Part D prescription drug “donut hole” coverage gap. They will receive a $250 rebate check this year as we transition to the complete closure of the prescription drug coverage gap by 2020.

At that same home, I met seniors who immediately were able to access free preventative care in Medicare. As of today, key preventive health care is available without co-pays or deductibles for every American entering a new plan. If your insurance company tries to deny you coverage recommended by your doctor – and we know sharks at the insurance companies will certainly try – you now have the right to seek an independent appeal from an outside watchdog.

(I hope it gives you some comfort to know that the new Director of the Division of Enforcement in the Office of Oversight at the Department of Health and Human Services’ Office of Consumer Information and Insurance Oversight is Gary Cohen, my former Chief Legal Counsel at the California Department of Insurance. He worked with me to build the toughest consumer protection agency in America, and I look forward to watching Elizabeth Warren and him compete for the honor of that claim in the years ahead.)

I met a courageous young girl and her parents at my El Cerrito town hall. They had insurance through her father’s job, but they were terrified that if he was ever laid off, her pre-existing condition would prevent her from getting coverage. As of today, she can stay on his plan up to the age of 26.

That girl, intelligent and full of life, is also eligible for the high-risk pool, and we designed the law to guarantee her access to an individual plan. I end on this note, because it provides a constructive lesson in what still needs to happen. We learned yesterday that major insurance companies, including Anthem Blue Cross, Aetna, and Cigna, plan to stop offering children’s-only health plans instead of obeying the new Patient’s Bill of Rights that requires companies to offer health insurance to children. That is unacceptable.

We created the most pro-consumer, pro-patient framework for health care delivery ever in the history of our great nation. With some of the reforms, the insurance companies backed down and accepted that their insatiable greed would be restricted. With other changes, like children’s coverage, some of the greediest insurance companies continue to try and skirt around the rules. Our work is never done, but as we address the abuses of the insurance companies, the Patient’s Bill of Rights really continues helping real people.

Congressional Republicans have pledged to repeal and defund the Patient’s Bill of Rights. They have pledged to take away vital patient protections and put insurance companies back in charge. We can’t let the Republicans tear down all that’s been accomplished for Gail and the millions of Americans like her.

Congressman John Garamendi served eight years as California's Insurance Commissioner, where he was widely credited for creating the best consumer protection agency in America. He authored a near-universal health care bill that was a key inspiration to President Bill Clinton's health care proposals in the early 1990s.

It's a Shame

It would be a damned shame if we finally lost a constituency as prized as seniors because of the current Democratic president. And yet that appear to be exactly what’s happening. In the summer of 2009, there were reports of a Democratic “problem” with seniors. Victoria McGrane and Chris Frates, writing in POLITICO, described how the town hall rage was being fueled by senior citizens. Seniors, angered by proposed cuts to Medicare floating around Congress, controversial talk of “death panels,” and the like, promised to be a concern for Democrats in the upcoming midterm elections. In 2008 they backed John McCain over Barack Obama by 8 points.

More than a year later, the news hasn’t gotten any better, according to The Washington Post. A full 66% of older voters are enthusiastic about voting in November, and most of them to ready to cashier the Democrats. And they should be. Since they are free of the responsibilities of governing, the vocal conservative opposition has often been right.

And they should be. Since they are free of the responsibilities of governing, the vocal conservative opposition has often been right. In addition to the ones that exist with private insurance, the possibility of governmental rationing regimes is not beyond the realm of possibility. People often confuse them with the completely innocuous concept of end-of-life counseling, which had been supported by Republicans in years past. The death panels, however, are notions of governmental bureaucrats—full of fulsome praise for the British system of rationing—with the power to deny care for the sake of cost-cutting. Responding to the criticism his work has engendered bioethicist and administration official Ezekiel Emanuel assured he was “writing really for political philosophers. ... [T]he average person, it's not what they're used to reading.”

As far back as 2009, there were new reports contradicting the president’s public statements that there were no cuts to Medicare in any of the proposed legislation. These days you find conservative activists warning us in the pages of The Wall Street Journal that the new reform law will: “Cut $818 billion from Medicare Part A (hospital insurance) from 2014-2023, the first 10 years of its full implementation; [Cuts] for Medicare Part B (physicians fees and other services) brings the total cut to $1.05 trillion over the first 10 years.”

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Weekly Pulse: End-of-Life Counseling Returns, But Death Panels Still Nonsense

by Lindsay Beyerstein, Media Consortium blogger

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

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