November 13, 2005

Drug Benefit Fraud

Paul Krugman eludicates in his column the Deadly Doughnut one thing I'd heard from a retired relative: why has my relative been told to ignore the new prescription drug benefit? Well, if my relative signs up for this "benefit", he can't use the supplemental insurance his pension provides to cover his presciption drug benefits.

But if your cumulative drug expenses reach $2,250, a very strange thing will happen: you'll suddenly be on your own. The Medicare benefit won't kick in again unless your costs reach $5,100. This gap in coverage has come to be known as the "doughnut hole." (Did you think I was talking about Krispy Kremes?)

One way to see the bizarre effect of this hole is to notice that if you are a retiree and spend $2,000 on drugs next year, Medicare will cover 66 percent of your expenses. But if you spend $5,000 - which means that you're much more likely to need help paying those expenses - Medicare will cover only 30 percent of your bills.

....People with high drug costs will have relatively low out-of-pocket expenses for part of the year - say, until next summer. Then, suddenly, they'll enter the doughnut hole, and their personal expenses will soar. And because the same people tend to have high drug costs year after year, the roller-coaster ride will repeat in 2007.

How will people respond when their out-of-pocket costs surge? The Health Affairs article argues, based on experience from H.M.O. plans with caps on drug benefits, that it's likely "some beneficiaries will cut back even essential medications while in the doughnut hole." In other words, this doughnut will make some people sick, and for some people it will be deadly.

The smart thing to do, for those who could afford it, would be to buy supplemental insurance that would cover the doughnut hole. But guess what: the bill that established the drug benefit specifically prohibits you from buying insurance to cover the gap. That's why many retirees who already have prescription drug insurance are being advised not to sign up for the Medicare benefit.

Yup, this was a "benefit" designed to help only the drug companies. They sure want to make it clear to people who insist on using too many prescription drugs that they need to be "responsible consumers". Even if they die because they can't afford to cover the excess or pick a plan that doesn't cover the drugs they need.

Remember, this bill also makes it illegal for the government to negotiate with drug companies for lower prices. They've rigged the system everyway they can.

Furthermore, many seniors are very worried and confused about this change and wonder why it had to be so complicated.

"I have a Ph.D., and it's too complicated to suit me," said William Q. Beard, 73, a retired chemist in Wichita, Kan., who takes eight prescription drugs, including several heart medicines. "I wonder how the vast majority of beneficiaries will handle this. I fervently wish that members of Congress had to deal with the same health care program we do."

It's obvious that the reason it is so complicated is that this benefit was written to benefit the drug companies - and not the seniors who are only a means to the end. It seems to me that the goal of the Bushies and the radical Republicans is to make all Americans hate the federal government. Government is the problem, indeed.

Posted by Mary at November 13, 2005 11:49 PM | Health/Medicine/Health Care | TrackBack(1) | Technorati links |

This probably explains why my Grandfathers benefit provider sent me a big old packet on how great the coverage was. (he is in a nursing home). Nice....

Posted by: Jimmy at November 15, 2005 12:07 PM