Jeoffry Gordon, MD, MPH comments on the Medicare prescription bill passed by the US House of Representatives yesterday:
"The legislation to cover some drug benefits under Medicare passed by the US House of Representatives late on June 27 is the most cynical, misguided, disrespectful, insensitive and inappropriate, demeaning political pabulum yet. It requires about a $400 a year premium and $250 a year deductible to be funneled through private insurers. It is "means tested" to allow subsidies to poorer patients (earning less than 175% of poverty level - does anyone know what percentage of people over 65 fall into this category?); leaves a gap in coverage for any pharmacy expenses between $2001 and $3700; and avoids any impact on pharmaceutical costs and pricing. This legislation will markedly change the social insurance model of the Medicare program, provide less than adequate pharmaceutical coverage from even the middle class point of view (involving up to $2350 in out of pocket expenses for medicines alone before the government picks up the full cost), requires an expensive administrative nightmare to not just keep track of pharmaceutical expenditures, but also to intrusively inquire into the level of every beneficiaries' income, while providing an incredible financial windfall to the insurance and pharmaceutical industries. Everyone interested in a solution to our current health system collapse must use the perversities of this proposal to demonstrate how a single payer, universal coverage, comprehensive health system is the only meaningful reform."
Comment: For the first $3700 of prescription coverage the Medicare beneficiary must pay a $33/month premium ($396), a $250 deductible ($250), 20% of costs up to $1000 ($150), 50% of costs up to $2000 ($500), and 100% of costs up to $3700 ($1700). The out-of pocket expense is $2996 for a $3700 benefit. Thus the beneficiary is paying 81% to receive a 19% insurance benefit. With the beneficiary providing the primary funding and the insurance company paying nominal cost-sharing, this reverses the ratios of traditional health care insurance. And this is to purchase an insurance product in the private market that the insurance industry has stated will not be offered.
Jeoff Gordon is right. We must use the perversities of this proposal to demonstrate that a comprehensive, universal, single-payer plan is the only meaningful reform.