Medicare Part D: The Clown Show Continues

by hilzoy

From yesterday's Chicago Tribune:

"A top Bush administration official acknowledged Thursday that the Medicare prescription program is too complicated for many of its intended beneficiaries to understand and said simplifying it is a top priority.

"Simplification is absolutely the next step in this process, now that we've got the benefit in place," Medicare administrator Mark McClellan said at a Senate hearing into the program that kicked off on Jan. 1."

Most people think that it's a good idea to figure out how a program will work, and then pass legislation to put it in place. Plan first; then execute. But that's pre-9/11 thinking! In the brave new world of the Bush administration, you pass the law before you figure out how to run the program, to "get the benefit in place", and then you figure out how it ought to operate. Nifty, huh? I'll bet they buy cars before figuring out what kind they want, and build buildings before hiring an architect -- just to get the structure in place before they get to work on the design. Why didn't we think of it before?

Besides, it's just a Medicare prescription drug program. It's not as though people are being denied life-saving medications, or being forced into nursing homes, or being told they just can't have any antipsychotic drugs anymore, or anything.

Meanwhile, back in the real world, the number of people who are being victimized by the negligence of the people who drafted this legislation continues to grow. The latest group? Independent pharmacists:

"More than a month after filling thousands of unpaid prescriptions for poor, sick customers, many of America's small and independent pharmacists, particularly those in low-income and rural areas, are facing a cash crunch as they await repayment from Medicare's private drug plans.

At Rose Drugs in central Tampa, Fla., many customers are poor people with HIV infections and elderly people on fixed incomes. When their drug coverage switched from Medicaid to Medicare on Jan. 1, store owner Rose Ferlita doled out medicines to combat their ailments even though she couldn't always verify their enrollment in the new Medicare drug benefit.

"What are you going to do?" Ferlita asked. "My friends are my customers and my customers are my friends. You've got to give them something."

As weeks passed and the enrollment problems mounted, Ferlita took out a $40,000 loan to help pay the drug wholesalers who wanted their bills paid now, not when the hoped-for Medicare payments came in.

"Two capsules here, three capsules there. It sounds like nothing, but when they're HIV meds, they're expensive. So I'm praying to God it's going to even out," Ferlita said. "Everyone had an expectation that this was going to be a smooth transition, but it hasn't been. Not even close."

Faced with the prospect of elderly and disabled customers going without life-sustaining drugs, many pharmacists have given out tens of thousands of dollars in medication. As the bills for those drugs came in from their wholesalers, pharmacies have had to pay them while waiting for the plans to reimburse them."

Republicans: the party that cares about small business.

Ha. Ha. Ha.

Comments

[Jimbo]

Serenity now, serenity now.

[Simp]

Again, this administration dosen't give a hoot about sound policy. This was always about letting the pharma lobbists write some beneficial legislation. Now that the give-a-way is in place and it is an election year, they are going to act like they are motiviated to fix it.

Yet the only fix is to eliminate it and start over. A novel approach may be to start with the premise of a program that primarily benefits those on Medicare first. But then again we know that government doesn't work for the people, unless you are people with power, money and influence.

Sorry for the lame post, I've just had it with the sorry state that this Republic has become. This administration is a joke.

[Nell]

You do that design-first, then-implement thing when you care at all about the real-world results for people (rather than Pharma corps). When a program is purely a political marker, designed mainly to deny the opposition the use of the issue, that part doesn't matter one bit. You just 'get the benefit in place.'

(Of course, you want to make absolutely sure in the design phase that you're not missing any opportunities to enrich pharmaceutical corporations; but you can count on their help in that process.)

[alan]

A story in the Times tomorrow seems all out of whack in any number of ways, but there is a real gem of a quote from rep. Bill Thomas:

"What I find ironic is the Democrats and the labor unions chose to trash this law for two full years, and then in the 11th hour say we need to extend the signup because people are confused," Mr. Thomas said. "Who produced the confusion?" He also faults the news media for highlighting those complaints rather than the accomplishments of the program.

Who produced the confusion? Priceless.

[Gary Farber]

Another quote, Alan:

"We got the bill we could get," said Mr. Thomas, a California Republican. "And then those who tried to make sure it wasn't law began immediately to attack it."

Yes, it's just horrible. People who thought it was a terrible bill before it was passed continued to say it was an awful bill after it was passed!

Shocking!

Only Democrats would do such a thing, of course. Not Republicans!

Why, once a law Bill Clinton proposed was passed, Republicans loyally fell into line, and never again had other than a word of praise for it!

We all remember that, I'm sure.

John Feehery, a former top aide to J. Dennis Hastert of Illinois, the speaker of the House [said]: ["]If Democrats were in control, they would have just fixed prices and let the government pay for it."

Indeed. Just like the Clinton health plan.

Accurate next line in the story:

In fact, many liberals argued that the easiest way to add a drug benefit to Medicare was, quite simply, to add a drug benefit to Medicare.

Crazy idea, that was. Only a Democratic fool would propose such a stupid notion!

My magic mind-reading cap senses Hilzoy working on her comment even now.

[hilzoy]

Gary: nah, I was reading this story on the mentally ill under Medicare Part D. Excerpt:

"But repeatedly, she and others say, people have fallen through the program's cracks and discovered they have no insurance -- and have either run out of pills or rationed their medicine because they feared they would be left without.

Or they have been assigned to plans that will pay for some but not all of their psychiatric prescriptions -- an untenable and potentially dangerous situation given the complicated multiplicity of drugs people often take, with some pills to treat symptoms and others to counteract side effects. Unlike many medicines, psychiatric drugs are not easily substituted.

In Alexandria last month, a mother of two with a history of homelessness and attempted suicide left a drugstore empty-handed after being told her antidepressant was not covered. "For her, it was overwhelming," said Lix Wixson, director of acute care at the local Community Services Board. "She shut down."

The agency bought her a week's supply of Lexapro while it changed her plan and stabilized her condition. In fact, it made repeated purchases for clients in January at a cost exceeding $2,400. That's money unlikely to be reimbursed. "We can't do that indefinitely," Wixson said."

As I wrote before, wrecking people's psychological health is just wrong in so many different ways: bad for them, bad for their communities and families, and (least important, but galling) ruinously expensive, when you take account of e.g. people who will be hospitalized instead of living in assisted living or group homes.

It makes me furious.

[Pooh]

It's really a simple process.

"Ready. Fire! Aim."

[Gary Farber]

"It makes me furious."

Yeah. I'm glad I'm in a good mental place in recent weeks, again, myself, so I'm not actually literally emotionally upset to read this -- and also I simply couldn't be less surprised, I'm afraid -- but utter intellectual agreement. It's -- what's the word?

Oh, yeah! "Evil."

"...and have either run out of pills or rationed their medicine because they feared they would be left without."

And, hey, that's why Gary had little blood pressure or other medication from February, 2005 through January, 2006 (and plenty of other times further back)! Because he had to ration, or ran out, and couldn't afford the ~$160/month his prescriptions cost at the ultra-cheap-pharmcy the Boulder People's Clinic recommends (damn commie name, if you ask me, even though it's a private non-profit, and they charge a minimum of $10/visit). But enough about me (I was able to afford resupplies in January, and have just re-stocked in February, thanks to various factors, including generous donations, and some paid writing gigs; probably March will be okay, as well, knock wood; can't see further than that for now).

Speaking of outrage, you might want to check on the post I'll likely leave as the top one on my blog until morning on the insidious lesbian conspiracy reaching the Bahamas. As might anyone who might give thought to vacationing in the Bahamas any time soon. Or who cares about gay rights, and our Liberal Gay Agenda.