The Effect of Medicare Part D
I would love for anyone to explain to me precisely how giving power over millions of seniors and disabled to over 300 private insurance companies with no oversight and no penalty for not, in fact, adhering to their contracts could POSSIBLY have an even marginally acceptable outcome, much less trying to change all these millions of people over on the same day! All things considered, I’d say it was a miracle that most people who were eligible had not signed up by January 1.
In fact, there are many seniors and disabled across the nation who still do not have their medicines, and have no idea when or how they will get them if in fact they ever will. The burning question is whether this mess will be untangled before people die because they do not have the medicines required to keep them alive. Some pharmacies, and even some states, have stepped into the void for a short time and on a limited basis. Most have not, because they simply do not have the funding to do so.
While this certainly generated some excellent press, I doubt there was any question in anyone’s mind who was even remotely educated in regard to how this was supposed to work, which of course eliminates anyone who works for Medicare, Social Security, or, for the most part, anyone answering the phone for any of the insurance companies, whether it would be a viable program or not.The fact that the “dual-eligibles”, those elderly and disabled who are eligible for both Medicare and Medicaid for the simple reason that we as a society do not allow them enough monetary help to survive, much less to survive AND buy their medicines, were randomly assigned to insurance companies with absolutely no regard as to whether the medications they take were even covered by the company to which they were assigned clearly shows that no one is paying attention and that, in fact, no one cares. Oh, wait! That was covered by putting into the companies contracts that they would cover transition drugs. The problem is, that will cost the companies millions of dollars, and there is no penalty for not living up to their contracts. When the time came, most transition prescriptions were not covered.
Those of us who had gotten our medication costs down to a manageable level by utilizing patient assistance programs are also victims of this bad legislation, because if you have any prescription coverage, no matter how poor or incomplete, you are no longer eligible for most of the programs and in fact, some of them will not cover anyone who is eligible, whether they have signed up or not, and some will be shut down completely. The state department of insurance director kept telling me that I would be saved SO much if I had had to pay for my medications that I should be delighted that my prescription costs will only triple with Medicare Part D. Of course, she couldn’t decide whether I should make my house and utility payments or live in my van and buy my meds. That, of course, has to be my decision….and I’m not being facetious. You have to get a chuckle out of the fact that my blood pressure medication, which is $45.45 a month if I simply buy it outright at the pharmacy, will cost me $60.00 if I buy it through Humana, which is, according to that same insurance department director, the best of the 43 plans available to me. Yes, I know, I can appeal it, and they’re SUPPOSED to honor appeals. They were supposed to supply transition drugs too.
Frankly, my suggestion to our president and legislators who thought that this was such wonderful, ground-breaking legislation is that they simply line all the disabled and elderly in this country up and shoot us. The press won’t be great, but it would certainly be better than what they’re doing now, at least from our standpoint. A quick and merciful death will be my choice over a miserable, prolonged one any day.
The sad part is that there is a very easy fix for this. First of all, deprivatize it. There is not an insurance company on earth that
has its customers welfare at heart. They are concerned with their bottom line, and their bottom line suffers every single time they have to make a payout.
Find someone who is savvy and who is hard nosed enough to negotiate directly with the drug companies for, literally, billions of prescriptions every year. If a US company refuses to offer a reasonable price, go to overseas manufacturers who are willing to immediately bring their facilities up to US standards and who are willing to subject to frequent and unannounced inspections in return for contracts. There will be plenty of them, believe me. They will line up around the globe.
If a person was dual eligible prior to this nonsense and was not having to pay for their meds, it’s obviously because they can’t
survive and afford them. Furnish them free. If they were dual eligible and had a spend down, look at the spend down to see if it was, in fact, realistic. In my experience, it generally is not. If it is not, give them a $1 copay for generics, a $5 copay for brand
names for which there is no generic, and a $10 copay for brand names if they have a generic for the medication but the patient refuses to use the generic unless there is a provable medical reason not to use the generic, which there occasionally is. There should be no premium for any of these folks, because they simply can’t afford it. For people at higher income levels, institute a monthly premium starting at, say, $10 for those with incomes from 12K-18K a year (for one person), and the same copays as the lower income folks, with a sliding scale as the income increases.
Will this program lose money? Perhaps. Certainly on some members it will. However, if you combine the Medicare program premiums together and pay all claims, whether for drugs, doctor visits, or hospitaliations from the same pocket, it should be a viable plan. HMO’s and PPO’s make it work to their advantage. There’s no reason the government can’t as well. There will be years when there is a deficit, and years when the current costs will be met and the deficits covered as well.
Or, of course, there is the option of lining us all up………
