PNHP

AMA's support of Medicare bill will come back to bite them

AMA's support of Medicare bill will come back to bite them

American Medical News
Dec. 22/29, 2003
Medicare law starts clock on fixing payment formula
By Markian Hawryluk

With a stroke of his pen on Dec. 8, President Bush signed away two years of future cuts in Medicare payments to doctors. But amid the glee over the averted crisis, physician groups realized they have just those two years in which to avoid a disastrous situation.

The Medicare bill signed into law would set updates at a minimum of1.5% in 2004 and 2005. But because the payment update formula was left primarily intact, the extra spending over the next two years will have to be recouped in 2006 and beyond. Unless the pay formula is revised or eliminated by that time, physicians can expect a sharp reduction, or cliff, in payment.

“As the cliff physicians face in 2006 illustrates, a Band-Aid can only stop the hemorrhaging for so long,” said Carl Pepine, MD, president of the American College of cardiology. “The sustainable growth rate formula for making annual updates to Medicare fees is still inherently flawed and does not accurately reflect the cost of physician services…”

http://www.ama-assn.org/amednews/2003/12/22/gvl11222.htm

Comment: For an advance loan for the next two years which will have to be paid back through a reduction in future fees, the AMA agreed to support legislation that is designed to reduce federal funding of the entire Medicare program. Not only will they have to pay off this advance in fees, but they will have a relatively smaller pool of funds from which to draw future reimbursements. How is the AMA going to negotiate a better payment formula when the politicians will protest that we can’t afford to pay for both prescription drugs and physician fee increases?

Physicians who are more than two years away from retirement will find it in their interest to start supporting a universal program of social insurance that will recover $280 billion in administrative waste and spend that on patient care instead. More money for patient care means more money for physicians.

75% of physicians aren’t even AMA members. They should think about joining an organization that has a mission to dramatically improve the way we fund health care: Physicians for a National Health Program. By supporting reform that places the patient first, physicians will fare very well.

PNHP website, including membership information:

Physicians for a National Health Program

AMA’s support of Medicare bill will come back to bite them

American Medical News
Dec. 22/29, 2003
Medicare law starts clock on fixing payment formula
By Markian Hawryluk

With a stroke of his pen on Dec. 8, President Bush signed away two years of future cuts in Medicare payments to doctors. But amid the glee over the averted crisis, physician groups realized they have just those two years in which to avoid a disastrous situation.

The Medicare bill signed into law would set updates at a minimum of1.5% in 2004 and 2005. But because the payment update formula was left primarily intact, the extra spending over the next two years will have to be recouped in 2006 and beyond. Unless the pay formula is revised or eliminated by that time, physicians can expect a sharp reduction, or cliff, in payment.

“As the cliff physicians face in 2006 illustrates, a Band-Aid can only stop the hemorrhaging for so long,” said Carl Pepine, MD, president of the American College of cardiology. “The sustainable growth rate formula for making annual updates to Medicare fees is still inherently flawed and does not accurately reflect the cost of physician services…”

http://www.ama-assn.org/amednews/2003/12/22/gvl11222.htm

Comment: For an advance loan for the next two years which will have to be paid back through a reduction in future fees, the AMA agreed to support legislation that is designed to reduce federal funding of the entire Medicare program. Not only will they have to pay off this advance in fees, but they will have a relatively smaller pool of funds from which to draw future reimbursements. How is the AMA going to negotiate a better payment formula when the politicians will protest that we can’t afford to pay for both prescription drugs and physician fee increases?

Physicians who are more than two years away from retirement will find it in their interest to start supporting a universal program of social insurance that will recover $280 billion in administrative waste and spend that on patient care instead. More money for patient care means more money for physicians.

75% of physicians aren’t even AMA members. They should think about joining an organization that has a mission to dramatically improve the way we fund health care: Physicians for a National Health Program. By supporting reform that places the patient first, physicians will fare very well.

PNHP website, including membership information:

Physicians for a National Health Program

If insurance doesn't work for people with disabilities, would it work for the rest of us?

The Henry J. Kaiser Family Foundation
December 2003
Understanding the Health-Care Needs and Experiences of People with Disabilities
By Kristina Hanson, Tricia Neuman and Molly Voris

Although most people with disabilities do have some form of health insurance
coverage, those who are both uninsured and disabled are at a particular disadvantage in the current health-care system. They are more likely than
others to forgo or delay getting necessary care, including the prescription
drugs and preventive services that would reduce their future need for health-care services.

The findings from this survey also demonstrate that all sources of insurance
are not created equal in meeting the needs of people with disabilities. Private insurance is often perceived as the most generous source of coverage, generally serving those with higher incomes. However, even those with private coverage often have significant problems paying for various services due in part to high cost-sharing requirements and the lack of coverage of specific services often needed by people with disabilities, such as personal assistance services.

Despite Medicaid’s relative generosity… specific Medicaid benefits do vary considerably by state… In addition, in the face of rising costs and budget
shortfalls, states are currently looking for ways of slowing growth in program spending, such as curtailing benefits, increasing cost-sharing requirements, and restricting eligibility.

… beneficiaries who rely on Medicare as their sole source of coverage are
far more likely than those with either Medicaid or private insurance to delay care, go without needed equipment, and forgo medicines due to costs.

In conclusion, the findings from this survey highlight the diverse needs of non-elderly adults with disabilities, while also demonstrating the need for significant improvements in the health-care coverage available to this population. Along with extending coverage to particularly disadvantaged groups of people with disabilities without insurance altogether, future policy debates should focus on strengthening the coverage currently offered through both public and private sources of insurance to improve health care and quality of life for Americans with disabilities.

http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=28401

Comment: The disconcerting news is that none of our current programs are
ensuring full access to care for people with disabilities. What should be of
concern to the rest of us is that we, likewise, have no assurances that our
needs would be met should we ever be unfortunate enough to develop a long-term disability. But isn’t that one of the major reasons why we have
health insurance?

Our current policies are aimed at shifting more of the costs to patients, and reducing funding of our risk pools whether they be public programs, employer-sponsored plans or other private plans. Isn’t this moving in the wrong direction?

Let’s now demand equitable and efficient use of our generous health care
resources. We can do this by establishing our own public program of universal health insurance. Then we would all be assured of both health security and financial security should the need arise.

If insurance doesn’t work for people with disabilities, would it work for the rest of us?

The Henry J. Kaiser Family Foundation
December 2003
Understanding the Health-Care Needs and Experiences of People with Disabilities
By Kristina Hanson, Tricia Neuman and Molly Voris

Although most people with disabilities do have some form of health insurance
coverage, those who are both uninsured and disabled are at a particular disadvantage in the current health-care system. They are more likely than
others to forgo or delay getting necessary care, including the prescription
drugs and preventive services that would reduce their future need for health-care services.

The findings from this survey also demonstrate that all sources of insurance
are not created equal in meeting the needs of people with disabilities. Private insurance is often perceived as the most generous source of coverage, generally serving those with higher incomes. However, even those with private coverage often have significant problems paying for various services due in part to high cost-sharing requirements and the lack of coverage of specific services often needed by people with disabilities, such as personal assistance services.

Despite Medicaid’s relative generosity… specific Medicaid benefits do vary considerably by state… In addition, in the face of rising costs and budget
shortfalls, states are currently looking for ways of slowing growth in program spending, such as curtailing benefits, increasing cost-sharing requirements, and restricting eligibility.

… beneficiaries who rely on Medicare as their sole source of coverage are
far more likely than those with either Medicaid or private insurance to delay care, go without needed equipment, and forgo medicines due to costs.

In conclusion, the findings from this survey highlight the diverse needs of non-elderly adults with disabilities, while also demonstrating the need for significant improvements in the health-care coverage available to this population. Along with extending coverage to particularly disadvantaged groups of people with disabilities without insurance altogether, future policy debates should focus on strengthening the coverage currently offered through both public and private sources of insurance to improve health care and quality of life for Americans with disabilities.

http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=28401

Comment: The disconcerting news is that none of our current programs are
ensuring full access to care for people with disabilities. What should be of
concern to the rest of us is that we, likewise, have no assurances that our
needs would be met should we ever be unfortunate enough to develop a long-term disability. But isn’t that one of the major reasons why we have
health insurance?

Our current policies are aimed at shifting more of the costs to patients, and reducing funding of our risk pools whether they be public programs, employer-sponsored plans or other private plans. Isn’t this moving in the wrong direction?

Let’s now demand equitable and efficient use of our generous health care
resources. We can do this by establishing our own public program of universal health insurance. Then we would all be assured of both health security and financial security should the need arise.

National health-care anarchy isn't serving Americans well

Sunday, December 14, 2003
National health-care anarchy isn’t serving Americans well
By Froma Harrop
Providence Journal columnist

The next person to call me liberal for advocating a national health plan is in for a tongue-lashing – or I’ll just hand him a copy of this column. What we have now is anarchy. We have government plans, private coverage, no coverage, not enough coverage. There are untreated illnesses, overtreatment, too many pills, pills that cost too much, federal regulators and state regulators.

It happens that the best arguments for universal coverage with a strong federal hand are conservative ones. But conservatives are the last ones to make them. Or, to be more accurate, Richard Nixon was the last conservative to make the case, and that was a long time ago.

Why should conservatives support making health insurance primarily a federal responsibility?

For starters, it would help American business. Asking America’s employers to pay for their workers’ health care makes no sense. Why not ask them to pick up their employees’ supermarket tabs or dry cleaning bills, as well?

The practice started during World War II, when the government froze wages. Factories desperate for workers offered health benefits instead of pay raises. The idea grew, and that’s why today’s employers are funding our allergy shots and heart bypasses.

Many also cover lots of hangers-on – workers’ spouses, children and domestic partners. About two-thirds of Americans younger than 65 now obtain coverage through someone’s employer. And some generous companies cover their retirees, also. General Motors, for example, now pays the medical bills of one-half of 1 percent of all Americans.

Businesses also end up paying for the uninsured. Because law requires hospitals to treat every comer, people without coverage go to hospitals for their medical needs, major and minor. Many don’t pay their hospital bills. Hospitals offset these losses by raising fees for paying customers – that is, the insured. The upshot is higher premiums for employers.

The system burdens America’s businesses in other ways. Companies must hire people just to administer their workers’ medical benefits. And the employer that spends money on good benefits is put at a competitive disadvantage to companies that do not. Health care raises its labor costs.

Our employment-based health-care system costs jobs: Health costs have spurred U.S. companies to move their operations elsewhere. For example, American automakers like making cars in Canada, because the Canadian government pays for medical care.

The cost of insuring workers makes companies wary of hiring more people. When business heats up, they prefer asking current workers to put in more hours. That’s because paying time-and-a-half wages is often cheaper than providing an expensive health-care package to a new worker.

There are strong “family values” arguments for universal coverage. Social conservatives want mothers to stay home with their young children. I know several young mothers who would do so, were it not for the health-insurance problem. They have husbands who work – but in jobs lacking family coverage. These families can plan for a year or two of a parent’s lost wages. But they won’t risk having a family member come down with a serious illness requiring $100,000 worth of medical care and no coverage.

It’s time to shatter several myths about a national health plan. One is that it must be a restrictive single-payer program, like Canada’s. The systems in France and Germany combine a basic government guarantee of coverage with the option of buying fancier care through private insurance.

Another myth is that a national health plan would be expensive. Actually, it would save the U.S. economy money. Our muddled system sends administrative costs skyrocketing and wastes medical resources. As a result, the United States now spends 14 percent of its gross domestic product on health care, versus the 11 percent spent in Germany and 10 percent in France.

A third myth is that workers don’t pay for company health benefits. They do. Money that their employer spends on their health coverage comes out of their paychecks. Without that expense, employers could raise salaries.

So let’s free the American corporation! Let Acme Widgets make widgets and not worry about its foreman’s asthma condition. Let’s free the American mother (or father) to stay at home with the kids and not have to work just for health coverage.

Today’s health-care system offers neither a liberal nor a conservative vision. It’s anarchy, pure and simple.

Froma Harrop is a Providence Journal columnist. Contact her by writing to
fharrop@projo.com.

National health-care anarchy isn’t serving Americans well

Sunday, December 14, 2003
National health-care anarchy isn’t serving Americans well
By Froma Harrop
Providence Journal columnist

The next person to call me liberal for advocating a national health plan is in for a tongue-lashing – or I’ll just hand him a copy of this column. What we have now is anarchy. We have government plans, private coverage, no coverage, not enough coverage. There are untreated illnesses, overtreatment, too many pills, pills that cost too much, federal regulators and state regulators.

It happens that the best arguments for universal coverage with a strong federal hand are conservative ones. But conservatives are the last ones to make them. Or, to be more accurate, Richard Nixon was the last conservative to make the case, and that was a long time ago.

Why should conservatives support making health insurance primarily a federal responsibility?

For starters, it would help American business. Asking America’s employers to pay for their workers’ health care makes no sense. Why not ask them to pick up their employees’ supermarket tabs or dry cleaning bills, as well?

The practice started during World War II, when the government froze wages. Factories desperate for workers offered health benefits instead of pay raises. The idea grew, and that’s why today’s employers are funding our allergy shots and heart bypasses.

Many also cover lots of hangers-on – workers’ spouses, children and domestic partners. About two-thirds of Americans younger than 65 now obtain coverage through someone’s employer. And some generous companies cover their retirees, also. General Motors, for example, now pays the medical bills of one-half of 1 percent of all Americans.

Businesses also end up paying for the uninsured. Because law requires hospitals to treat every comer, people without coverage go to hospitals for their medical needs, major and minor. Many don’t pay their hospital bills. Hospitals offset these losses by raising fees for paying customers – that is, the insured. The upshot is higher premiums for employers.

The system burdens America’s businesses in other ways. Companies must hire people just to administer their workers’ medical benefits. And the employer that spends money on good benefits is put at a competitive disadvantage to companies that do not. Health care raises its labor costs.

Our employment-based health-care system costs jobs: Health costs have spurred U.S. companies to move their operations elsewhere. For example, American automakers like making cars in Canada, because the Canadian government pays for medical care.

The cost of insuring workers makes companies wary of hiring more people. When business heats up, they prefer asking current workers to put in more hours. That’s because paying time-and-a-half wages is often cheaper than providing an expensive health-care package to a new worker.

There are strong “family values” arguments for universal coverage. Social conservatives want mothers to stay home with their young children. I know several young mothers who would do so, were it not for the health-insurance problem. They have husbands who work – but in jobs lacking family coverage. These families can plan for a year or two of a parent’s lost wages. But they won’t risk having a family member come down with a serious illness requiring $100,000 worth of medical care and no coverage.

It’s time to shatter several myths about a national health plan. One is that it must be a restrictive single-payer program, like Canada’s. The systems in France and Germany combine a basic government guarantee of coverage with the option of buying fancier care through private insurance.

Another myth is that a national health plan would be expensive. Actually, it would save the U.S. economy money. Our muddled system sends administrative costs skyrocketing and wastes medical resources. As a result, the United States now spends 14 percent of its gross domestic product on health care, versus the 11 percent spent in Germany and 10 percent in France.

A third myth is that workers don’t pay for company health benefits. They do. Money that their employer spends on their health coverage comes out of their paychecks. Without that expense, employers could raise salaries.

So let’s free the American corporation! Let Acme Widgets make widgets and not worry about its foreman’s asthma condition. Let’s free the American mother (or father) to stay at home with the kids and not have to work just for health coverage.

Today’s health-care system offers neither a liberal nor a conservative vision. It’s anarchy, pure and simple.

Froma Harrop is a Providence Journal columnist. Contact her by writing to
fharrop@projo.com.

Cost sharing is bad for your health

Center for Studying Health System Change (HSC)
News Release
Dec. 12, 2003
Health Care Spending Growth Slows Sharply in First Half of 2003

Health care spending growth per privately insured American slowed in the first half of 2003, increasing 8.5 percent, a sharp drop from the 10 Percent increase in the second half of 2002, according to a Center for Studying Health System Change (HSC) study released today.

“Increased patient cost sharing is probably an important factor in the slowing of cost trends, but few experts expect this tool to substantially lower cost trends over the long term,” said Paul B. Ginsburg, Ph.D., coauthor of the study and president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

“Without more effective cost-control measures, the rising cost of health insurance will make coverage unaffordable to more and more Americans,” Ginsburg said.

“As patients are having to share more of the costs, the fact is that more and more patients go without care,” said Paul Ginsburg, president of the Washington, D.C.-based center (Agovino, Associated Press).
HSC release
http://www.hschange.com/CONTENT/634/

Associated Press article by Teresa Agovino:
http://www.chron.com/cs/CDA/ssistory.mpl/health/2289043

And…

The New England Journal of Medicine
December 4, 2003
The Effect of Incentive-Based Formularies on Prescription-Drug
Utilization
and Spending
By Haiden A. Huskamp, et al

In conclusion, we found large effects on the continuation of the use of medications and out-of-pocket expenditures for enrollees associated with the switch by one employer from a one-tier to a three-tier formulary involving across-the-board increases in cost sharing… The discontinuation of the use of medications such as statins and ACE inhibitors that are needed for the treatment of chronic illnesses raises important questions about potentially harmful effects of formulary changes and the associated changes in copayments.

http://content.nejm.org/cgi/content/abstract/349/23/2224

Comment: In order to control the premium increases in private health plans, insurers are reducing benefits and increasing cost sharing.

Conservatives contend that it is essential to make patients sensitive to cost so that they will make wise financial decisions on the care that they really need. Unfortunately, since most patients with significant health care needs have little disposable income, the only real choice that they will have is to do without. Innumerable studies have now confirmed that increased cost sharing
significantly reduces the utilization of beneficial health care services.

The health savings accounts (HSAs) which will go into effect next month will help neither those who deplete their accounts because of chronic disorders
nor those who are unable to fund their accounts. Insurance premiums for these less fortunate individuals will be made affordable only by reducing benefits and increasing cost sharing.

Ironically, those who are able to build large HSAs are precisely those who have the least health care needs. Neglecting the ill to benefit the healthy is not rational health policy.

No matter what we do, under the present fragmented system of funding care the increased trends in cost sharing will make health care unaffordable for moderate and low income individuals with significant health care needs.

The experiment with cost containment through greater cost sharing has already failed miserably when measured by its impact on those with greater needs.

Let’s abandon these perverse efforts and move forward by adopting an equitable, comprehensive, universal system of social insurance. That Will work.

Wal-Mart calls for a national solution

The New York Times
December 12, 2003
Letters

Health Plan at Wal-Mart

To the Editor:

Re “Wal-Mart’s Health Plan” (letter, Dec. 4):

More than 90 percent of our associates have health insurance, about Half through Wal-Mart and half through other sources like spouses or parents.

We strive to make our health plan affordable and not a burden to taxpayers. That’s why we pay approximately two-thirds of the cost.

Like other employers, we face escalating health care costs, leading to adjustments in premiums…

This crisis needs a national solution.

SUSAN CHAMBERS
Senior V.P., Benefits and Insurance Administration
Wal-Mart Stores
Bentonville, Ark.

Comment: And what national solution would that be? Perhaps a single, equitable, affordable, comprehensive program of national health insurance for everyone? Why not? It would work for Wal-Mart, and it would certainly work for all of the rest of us.

Message 2:

Date: Fri, 12 Dec 2003 10:02:08 -0800
Subject:: Additional comment about Wal-Mart

We shouldn’t gloss over the statement by Susan Chambers, Wal-Mart Senior V.P. for Benefits and Insurance Administration, that “This crisis needs a national solution.”

The call for a national solution is a clear call for leveling the Playing field. Establishing equity in health care is a compelling goal. Wal-Mart has made its initial move. We should grab it and run with it.

Don

Orange County Area seniors denounce Medicare drug law

Area seniors denounce Medicare drug law. People at meeting say they’re feeling more betrayed and angrier as details come to light about complex measure.

MAKING A POINT: Dr. Brenda Ross, mayor pro tem of Laguna Woods and member of People for a National Health Program, addresses Thursday’s meeting of the Health Care Council of Orange County in Santa Ana, where the changes in Medicare were discussed.

MINDY SCHAUER, THE ORANGE COUNTY REGISTER
• Answering some Medicare questions
By MAYRAV SAAR and DENA BUNIS

The new Medicare prescription-drug bill has given Lenore Rufrano some sleepless nights.

The 76-year-old retired nurse from Mission Viejo has read every word she could get her hands on about the landmark legislation. And it looked like she was going to have to give up the medigap policy that she counts on to fill the gaps in Medicare’s coverage and help her pay for her seven prescriptions.

“For the first time in my life, I started to think about what is more important,” Rufrano said. Could she continue to give her three children and grandchildren the Christmas gifts that she always has? Would going out to lunch once a week become a luxury she couldn’t afford?

As more details about the complicated law come to light, Rufrano has learned that the private medigap policy, which costs her almost $7,000 a year, won’t be taken away from her.

Beginning in 2006 when the prescription-drug plan kicks in, new medigap policies won’t be able to contain drug coverage. But anyone who currently has a medigap policy that includes drugs and wants to keep it will be able to.

“I’m so relieved,” Rufrano said. But she is still miffed at AARP, formerly known as the American Association of Retired Persons, for promoting a bill that she believes will force too many seniors into the managed-care plans that she wants no part of.

“They didn’t ask me. They didn’t ask anyone I know,” Rufrano said of AARP’s decision to support the plan.

EXTRA COVERAGE ALSO AFFECTED
Nine out of 10 people on Medicare have some type of supplemental insurance to help pay what Medicare doesn’t cover. Some have retiree health plans. Some who have low incomes are eligible for Medicaid – Medi-Cal in California – and others buy medigap policies from private insurance companies.

These policies generally pick up costs like the hospital deductible, the deductible and some co-payments for office visits and some home-care expenses. And three of the 10 federally standardized medigap policies offer some prescription drug coverage.

The 10 medigap policies are designated by letters A through J. The A policies cost the least and offer the least coverage. J policies cost the most and have the highest level of benefits.

Here’s what will happen to medigap policies under the new law.
• Policies A through G, which don’t offer drug coverage, will remain the same.
• As of 2006, all new H, I and J policies will not include prescription drug coverage. Anyone who has one of those policies, however, will be able to keep it and the prescription drug coverage as long as they do not enroll in the new Medicare Part D prescription drug plan. Lawmakers wanted to avoid anyone having duplicate coverage.
• As of 2006, two new medigap policies will be added. Policies K and L will have high deductibles and will not cover the deductibles for doctor visits. They will be designed to cover catastrophic costs.

FOR MORE INFORMATION
www.kff.org – This Kaiser Family Foundation site includes a Medicare calculator. Beneficiaries can insert income, drug costs and other information and the computer will calculate the amount of the benefit under the plan.
www.aarp.org – This Web site of the giant seniors organization has information about the Medicare law and the organization’s reasons for its support of the changes.

www.medicare.gov – This is the official U.S. government’s site for Medicare. More information can also be obtained calling (800) 633-4227.

Rufrano has company. A roomful of angry seniors and health-care advocates gathered at a town-hall meeting in Santa Ana on Thursday to rail against the bill and pledge support for the lawmakers who opposed it.

They wereangry at AARP. Angry at the legislators who passed it. Seniors have started sifting through the 7-lb. Medicare bill, and they are growing angrier with each page they read.

“It’s such a travesty, and people won’t know that until they need health care,” said Sandra Hester, a member of the Health Care Council of Orange County, which sponsored the event.

The town-hall meeting drew more than 40 people, including representatives from the office of Rep. Loretta Sanchez, D-Santa Ana.

Sanchez is the only one of the six House members representing Orange County who voted against the Medicare bill. None of those members or their staffs showed up at the forum.

Lawmakers are on recess until late January, and several members are out of the country. Sanchez was in Israel. Staff members of other House members said either they never received the invitation or their schedules were full.

Also absent were representatives from AARP, which lost 15,000 members after it supported the bill. Ernie Powell, advocacy representative for the organization, said AARP recognizes flaws in the bill but supported it as a “first step” toward providing prescription drug entitlements.

“From 1965 until a week and a half ago, there was no prescription drug benefit. There is now a benefit that can be worked on to be made stronger and to be made more beneficial,” Powell said.

Powell said AARP plans to work with Congress to repeal certain aspects of the bill, such as the provision that seniors can no longer buy cheaper drugs from Canada and Mexico.

But many people at the forum said they still felt betrayed. Reading a full-page newspaper ad that AARP took out in support of the bill, Ted Rosenbaum said AARP’s contention that the bill protects traditional Medicare was “an outright lie.”

Rosenbaum drew applause when he urged other seniors in the audience to send complaint letters to the politicians and organizations who supported the bill and ended with a rallying cry indicative of how grave the group considered the new law:

“We shall overcome!” he said.

click to view photo
————————————————————————
CONTACT US: (714) 796-6880 or msaar@ocregister.com

S. 1992 – Defense of Medicare and Real Medicare Prescription Drug Benefit Act

United States Senate
December 9, 2003
Statements on Introduced Bills and Joint Resolutions
(Page: S16127)

Mr. KENNEDY. Mr. President, today, along with Senator Bob Graham, I am introducing the “Defense of Medicare and Real Prescription Drug Benefit Act.” Congressman John Dingell is introducing companion legislation in the House of Representatives.

S. 1992. A bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to eliminate privatization of the medicare program, to improve the medicare prescription drug benefit, to repeal health savings accounts, and for other purposes; to the Committee on Finance.

Summary: Provisions of the Defense of Medicare and Real Medicare Prescription Drug Benefit Act

Title 1: Defense of Medicare

Repeals the premium support demonstration. Requires risk adjustment between private sector plans and Medicare. Medicare will pay private sector plans an amount reflecting Medicare’s cost for covering an individual, rather than paying HMOs a large markup as a result of failing to adjust for the better health of senior citizens who join HMOs.

Repeals PPO slush fund. Pays all private sector plans an amount equivalent to average Medicare costs, rather than paying an average of 109 percent of Medicare costs, as provided under the current legislation. Phased in over 5 years. Repeals Medicare spending cap.

Title II: Establishment of Real Medicare Prescription Drug benefit Eliminates coverage gap in 2006-2008, beneficiaries will pay 75 percent coinsurance in the coverage gap. In 2009-2011, they will pay 50 percent. In 2012 and subsequent years, they will pay the same 25 percent copayment as
under the initial coverage limit.

Eliminates discriminatory treatment of employer plans. Allows Medicaid wrap-around for dual eligibles. Eliminates assets test. Requires two stand-alone prescription drug plans to avoid federal fallback. Secretary defines classes and categories under any formula.

Repeals prohibition on Medigap coverage of prescription drugs. Modifies current Medigap policies covering drugs to wrap-around new benefit.

Phases out elimination of state “clawback.”

Title III: Reduction in Prescription Drug Prices

Allows reimportation from Canada with certification and inspection of Canadian exporters to assure safety of drugs. Repeals prohibition on government negotiating directly with drug companies for best prices and gives authority for such negotiations.

Title VI: Repeals Health Savings Accounts

http://thomas.loc.gov/cgi-bin/query/F?r108:1:./temp/~r108HTt6fm:e46026:

Sen. Kennedy’s press release:
http://www.senate.gov/~kennedy/statements/03/11/2003C10519.html

Comment: S.1992, the “Defense of Medicare and Real Medicare Prescription Drug Benefit Act,” would provide a bona fide prescription benefit for Medicare, and would protect Medicare as a program of social insurance. It would also repeal the health savings accounts (HSAs) which threaten all of us by reducing the affordability of care for those with the greatest health care needs.

This bill must be passed and signed. If the current Congress and President won’t do it, then we need to replace them with individuals who will.

Insurance CEO:We'll have national health insurance

Pittsburgh Post-Gazette
December 11, 2003
National health insurance inevitable?
Highmark CEO makes the case, says it may be solution to spiraling costs
By Pamela Gaynor

In spite of the wider role Congress created for private insurers in the recently enacted Medicare reform bill, the chief executive officer of the region’s largest health insurer yesterday said he believes the country will inevitably move toward a national health insurance plan for all age groups.

(Dr. Kenneth Melani, CEO of Highmark, Inc., when giving a speech at the University of Pittsburgh’s Graduate School of Public Health)… said a host of factors have driven double-digit increases in health care costs across the country the past four years, including technology, greater consumer demand from an aging population, litigation and labor costs. The increases, he said, had come without corresponding gains in life expectancy, earning much of the technology has proven to have dubious value.

With health care costs now accounting for roughly 15 cents of every dollar of the nation’s economic activity, he predicted a backlash among voters.

At some point, “Democrats will get into office and say the Republicans have made a big mistake. There will be sweeping reform and then we’ll have national health insurance,” Melani said. “That’s where I think we’ll end up.
I can’t say when.”

http://www.post-gazette.com/pg/03345/249907.stm

Comment: Highmark, Inc., a non-profit, Blue Cross Blue Shield affiliate, is the nation’s 11th-largest health insurer. As Highmark’s CEO, Dr. Melani has diligently followed the trends and shifting opinions in health care. As a noted insurance industry leader, his opinions certainly have credibility.

National health insurance is absolutely inevitable. It remains to be seen whether the politicians will have the courage to enact a program that ensures equity, comprehensiveness, affordability, and administrative efficiency through a publicly-administered and publicly-funded model.

It’s our task to be certain that everyone does understand the superiority of the public model.

Medicare Bill passed under cover of darkness

CONGRESS Democracy crumbles under cover of darkness
By SHERROD BROWN
Published: Thursday, Dec. 11 2003
(This Op-Ed ran in newspapers across the nation.)

House Republicans bend rules, press for votes during wee hours to escape
the light of accountability.

Never before has the House of Representatives operated in such secrecy:

At 2:54 a.m. on a Friday in March, the House cut veterans benefits by three votes.

At 2:39 a.m. on a Friday in April, the House slashed education and health care by five votes.

At 1:56 a.m. on a Friday in May, the House passed the Leave No Millionaire Behind tax-cut bill by a handful of votes.

At 2:33 a.m. on a Friday in June, the House passed the Medicare privatization and prescription drug bill by one vote.

At 12:57 a.m. on a Friday in July, the House eviscerated Head Start by one vote.

And then, after returning from summer recess, at 12:12 a.m. on a Friday in October, the House voted $87 billion for Iraq.

Always in the middle of the night. Always after the press had passed their deadlines. Always after the American people had turned off the news and gone to bed.

What did the public see? At best, Americans read a small story with a brief explanation of the bill and the vote count in Saturday’s papers.

But what did the public miss? They didn’t see the House votes, which normally take no more than 20 minutes, dragging on for as long as an hour as members of the Republican leadership trolled for enough votes to cobble together a majority.

They didn’t see GOP leaders stalking the floor for whoever was not in line.

They didn’t see Speaker Dennis Hastert and Majority Leader Tom DeLay coerce enough Republican members into switching their votes to produce the desired result.

In other words, they didn’t see the subversion of democracy.

And late last month, they did it again. The most sweeping changes to Medicare in its 38-year history were forced through the House at 5:55 on a Saturday morning.

The debate started at midnight. The roll call began at 3:00 a.m. Most of us voted within the typical 20 minutes. Normally, the speaker would have gaveled the vote closed. But not this time; the Republican-driven bill was losing.

By 4 a.m., the bill had been defeated 216-218, with only one member, Democrat David Wu, not voting. Still, the speaker refused to gavel the vote closed.

Then the assault began.

Hastert, DeLay, Republican Whip Roy Blount, Ways and Means Chairman Bill Thomas, Energy and Commerce Chairman Billy Tauzin – all searched the floor for stray Republicans to bully.

I watched them surround Cincinnati’s Steve Chabot, trying first a carrot, then a stick; but he remained defiant. Next, they aimed at retiring Michigan congressman Nick Smith, whose son is running to succeed him. They promised
support if he changed his vote to yes and threatened his son’s future if he refused. He stood his ground.

Many of the two dozen Republicans who voted against the bill had fled the floor. One Republican hid in the Democratic cloakroom.

By 4:30, the browbeating had moved into the Republican cloakroom, out of sight of C-SPAN cameras and the insomniac public. Republican leaders woke President
George W. Bush, and a White House aide passed a cell phone from one recalcitrant member to another in the cloakroom.

At 5:55, two hours and 55 minutes after the roll call had begun – twice as long as any previous vote in the history of the U.S. House of Representatives – two obscure western Republicans emerged from the cloakroom. They walked, ashen and cowed, down the aisle to the front of the chamber, scrawled their names and district numbers on green cards to change their votes and surrendered the cards
to the clerk.

The speaker gaveled the vote closed; Medicare privatization had passed.

You can do a lot in the middle of the night, under the cover of darkness.

U.S. Congressman Sherrod Brown, a Democrat from Ohio, is the ranking member on the Committee on Energy and the Commerce Subcommittee on Health.