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Health Care - What Happens When Drug Industry Writes Part D Law?

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posted on Nov, 3 2006 @ 09:57 PM
You get the monster made in hell! The PMA - Pharmaceutical Manufacturers Association - has been around a long time. For much of its existence, it was a strong advocate of ethical practices in business and especially in the medicines business. I guess you’d have to date the beginning of its sea change to mendacity with the passage of the Medicare Act in 1965. Medicare took retired seniors out of the charity wards and made them the most influential interest group in America’s health care industry. Well, Almost.

Harry Truman introduced a National Health Service in America after his 1948 re-election, as the Labor Government had done in England after its victory in 1945. He was met with overwhelming opposition. Not from the people but from the special interests. Say "selfish" interests. The AMA - American Medical Association - representing doctors had been the most vocal opponents. They were joined by the AHA - American Hospital Association - which had been hugely boosted by the Hill-Burton Act passed in 1946, in which the Federal government paid 50% of the cost of new hospital construction. Aside: For you Establishment Clause fans this law may have been the beginning of the end of religions in America. We’ll have to wait on that, though.

Resume. Finally, the HIAA - Health Insurance Association of America - which represents the insurance industry. In addition, it is part of the Republican Party’s traditional “small government” mantra and “self-reliance ethic” philosophy to oppose any government sponsored universal access health insurance plan.

To get the Medicare Act passed, the Democrats had to reach substantial compromises with those interest and lobbying groups. There were two compromises that are most significant. First, the government agreed not to set fees or prices for professional care. We gave doctors, laboratories and hospitals a blank check. In 2006, any licensed MD in America who has a decent personality, a passing knowledge of medicine and is willing to work 60 hours a week, can net a quarter million dollars a year. The second compromise was to make Medicare an 80% pay plan, and to let the HIAA members sell a supplemental insurance plan to the Medicare people to cover the remaining 20% of costs, along with deductibles and co-pays.

The Democrats gave that up, but they got one crucial concession in return. Instead of writing a hodge-podge of indecipherable policies, the government wrote 10 standardized policies, and required all companies to offer Plan A, the cheapest, and one other plan of their choosing in order to be allowed to sell what is called “Medi-Gap” or supplemental policies. This is a GAI - Guaranteed Annual Income - for the insurance companies. Those plans pay ONLY after Medicare accepts the claim, and then they pay 20% of the Medicare approved amount and they are through!

I have one of those plans, and pay I $149 a month. Blue Cross Blue Shield charges $180 for the same policy. By making all plans standard, a consumer can actually compare costs of plans offered by various companies. Competition! Anathema to private enterprise.

Plan D. By the time medications came under the Medicare umbrella, the HIAA and PMA made durn certain this logical and understandable Medi-Gap plan would not be applied to Plan D. The Republicans in league with the HIAA and PMA wrote Plan D. After just one year in operation, here are 5 suggestions from the “AARP” bi-monthly magazine.

The article is on page 38 of the November-December edition, and titled “Medicare D: Is It Time To Change?”
1) Is your plan still working? CMS - privatized operators of Medicare and Medicaid - requires 2 companies be available to every eligible Medicare person. If not, the government furnishes the coverage directly.
2) Are your drugs covered? Some plans have changed their formularies and some have dropped medicines from the list. Make sure your plan still covers the medications you need. YES, the companies may add, drop or charge more or less for a short list of drugs offered. The buyer is supposed to keep up with this.
3) Has your prescribed medicine gone generic? If so, it is up to you to get a new prescription to get the advantage of lower prices.
4) How big is your doughnut hole? This referred to the variations in premiums, variations in formularies, variations in placing the covered medicine in one of 3 price tiers. Then compare various policy prices to make your “informed” choice. Yes, you the patient must do this yourself. 5) How’s your money supply? If your income is less than 150% of the poverty level, you can receive help in Part D if you ask for it. Reduced premiums, lower deductibles and smaller co-pays. You still have to pick the right plan!
6) Change plans? Be sure to do so before December 8, 2006, to be ready for 2007. There is more, and it is ever worse than what I’ve summarized above. But I’ll spare you. Just be glad you don’t live in America if you ever get sick.

[edit on 11/3/2006 by donwhite]

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