Part D Is For Dumb, Not Disastrous

Dr. Jerry Avorn, author of the door-stopping Powerful Medicines, issued a broadside against the Medicare drug benefit in this morning’s New England Journal of Medicine. After cataloging the program’s start-up ills, he concludes:

Medicare Part D lives on, responding semiappropriately to noxious stimuli by flailing its limbs as best it can. It even shows some limited capacity for learning, and one important learning opportunity is just seven months away. Elderly citizens vote in droves, and many of them will have hit their "doughnut hole" by early November. At that point, they will let their legislators know how they feel about the program.

Well, I’m on record as predicting that the failing Medicare drug benefit will not be a political fiasco for the Republicans. Nor will it benefit many Democrats, who at this point seem constitutionally incapable of exploiting any issue, much less one that is filled with complexities.

Here’s why I’m sticking with the gut feeling that the drug issue won’t matter this fall. The Center for Medicare and Medicaid Services reported the other day that the government spent nearly $5 billion on Part D last month, the first full month of operation. The program is well on its way to shoveling out the $60 billion per year expected when the program was first announced.

Assume that four-fifths of that went to people who already had drug benefits via their employers or government programs. In other words, it primarily helped big companies, insurance companies and states that were already providing drug coverage, but are now being reimbursed by the federal government for their efforts. No happy seniors there, but nothing to be mad about either.

And that still leaves about a $1 billion a month or $12 billion a year that is going directly to previously uncovered seniors who have high drug bills and signed up for the program.

Will the donut hole piss them off, as Avorn suggests? A few, maybe. But healthier seniors with moderate drug bills under $200 a month will see real savings. The sicker ones will still be getting half their drug bills paid for by their plans. And those two groups are the ones most likely to vote based on this issue. How likely are they to turn against the checkwriters?

Bottom line: Medicare Part D? A mess at the start. Totally inadequate as a benefit. A giveaway to the drug companies on pricing. Yet a non-issue in this fall’s election, in my humble opinion.

That doesn’t make it a good program. By prohibiting CMS from negotiating prices or establishing effective formularies and turning over administration to the insurance industry, the architects of this program created nothing so much as a price support program for the drug industry and, not coincidentally, an opening in their ideologically-driven campaign to privatize Medicare.

President George W. Bush’s crony-filled Washington may be totally incompetent when it comes to war planning, disaster relief or anything remotely connected to public health and safety. But when it comes to creating a price support program for a favored industry with ideological overtones, this administration is filled with Gucci-clad geniuses.

Posted by gooznews at March 29, 2006 09:59 PM