December 07, 2003

My last Medicare Drug Bill rant...maybe.

I can hear what you're thinking already...oh, no, another rant about the Medicare Drug bill! Well, yes. More precisely, a rant about a little clause therein that no one bothered to mention (or want noticed) before President Bush signs it Monday Dec. 7, and the bill becomes law.

You've already heard about the billions in subsidies for drug companies, insurance companies, and big business that make up about half the spending in this $400 billion monstrosity, including the fact that it will likely cost much more than the claimed $400 billion. Indeed, that estimate has already increased to $436 billion in the last two months. You've already heard about the prohibition on re-importing drugs into the U.S. from Canada, something that will boost prices for all drug consumers, not just the seniors who will get benefits under the new plan, and pour billions of dollars more into the pockets of the pharmaceutical industry. You may have even noticed that there's something not exactly just about all the taxes on working families required to pay for Medicare, many of whom can not afford any health insurance at all, an amount estimated to rise to as much as $4,000/yr per household under this massive unfunded behemoth.

But what seniors, the purported winners in this typically Rube Goldberg monstrosity of a pork barrel, have not yet noticed is that the new legislation that is supposed to ease their problems with high drug prices may do the exact opposite, locking them out of any alternatives. You see, not only does the bill provide a benefit with a big hole in the coverage, a hole that will grow with inflation indexing, it also prohibits seniors from buying any outside drug coverage at all to fill those gaps in the new benefit.

As reported today in the New York Times, the New Medicare Bill Bars Extra Insurance for Drugs. If you're already covered by an employer retiree policy, those expenditures don't count towards the $3600/yr deductible in the new plan. And if the drugs you're using are not part of the Medicare formulary of approved drugs, your spending on those drugs won't count towards that deductible either. So no matter what, in the complicated rules of the new plan, of the first $5,100 in annual drug expenses the patient is responsible for $3,600, period, an amount which can't be reduced by using outside coverage of any sort, and which must be spent on "approved" drugs before Medicare starts picking up 95% of the tab. So get used to generics at full "manufacturer's suggested retal price," Grandma, and don't hold your breath waiting on formulary approval of those cutting-edge drugs that the drug companies claim they must have oodles of cash to develop.

To make things even "better," low-income seniors eligible for both Medicaid and Medicare would have to obtain their drugs through Medicare, which has a more restrictive formulary offering fewer approved drugs. States will be generally prohibited from supplementing Medicare drug coverage with Medicaid drug coverage. And states will not get the discounts and rebates they now receive from manufacturers under Medicaid. So costs for state Medicaid programs will rise as well, something you won't find in the glowing reports from Congress on what a wonderful bill this is, or in the estimated cost of same.

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