Dawson Church See book keywords and concepts | Changing the institutions without changing the flawed thinking behind them results only in hastening their collapse, as was evident in the Medicare prescription drug benefit passed by Congress in 2004; it brought forward the date of Medicare's insolvency by eight years.13 Asking how to get the uninsured into the system—which is as far as most policymakers thinlc—is like asking how to cram more passengers onto a train that is already jammed, has some cars that are falling to pieces while others are trimmed with diamonds, is about to crash, and is heading in the wrong direction anyway. | | Asking questions like, "How can we slow the growing cost of our medical system," "How can we pay for the Medicare prescription drug benefit," and "How can we bring the uninsured into the system," have taken public debate in entirely the wrong direction. They are the wrong questions. As long as pundits keep on asking them, they will get the wrong answers. If Western society sticks with its disease-centered and money-driven model, citizens' health will not improve, even as they continue to pay more. Good ideas are what we need; when our thinking changes, our institutions change. | Mike Adams, the Health Ranger See article keywords and concepts | You get an unmitigated disaster, and that's what we're seeing today with the Medicare prescription drug benefit program. This program, which is just legalized theft from one group of American taxpayers to another group of American consumers (mostly the elderly), originally promised to give people discounts on prescription drugs.
The program was supposed to cost "only" a couple hundred billion dollars. It turns out that, as usual, the politicians were lying. | Mike Adams, the Health Ranger See article keywords and concepts | California suckered yet again
California is suing the federal government over its bungled Medicare prescription drug benefit plan, which has left so many senior citizens without prescription drugs for so long that they're actually starting to regain some mental clarity and realize what's going on. That, of course, is unacceptable. | Joe Graedon, M.S. and Teresa Graedon, Ph.D. See book keywords and concepts | A 2006 survey carried out by Medco Health Solutions (a leader in managing prescription drug benefit programs) revealed a surprising lack of confidence in generics: "One quarter of the physicians surveyed stated that they do not believe generic medications to be chemically identical to their branded counterparts." The same survey found that "nearly one in five physicians believes generic drugs are less safe than brand-name medications, and more than one in four doctors (27 percent) believe generic medications will cause more side effects than brands. | Katharine Greider See book keywords and concepts | We are firm supporters of a prescription drug benefit under Medicare," she says in monotone, imitating the industry's repeated assurances on this score. "Don't even bother to show up," she says. "Just send a CD with it playing."
Adding a drug benefit to Medicare has, indeed, become the fulcrum of the debate. Public Citizen's investigation found that industry lobbyists spent a great deal of time in 1999-2000 on pricing issues, resisting drug-reimportation legislation as well as efforts to reform the pediatric-research incentive. | Marcia Angell, M.D. See book keywords and concepts | They will become even bigger with the Medicare prescription drug benefit, since they will administer much of the new coverage and keep a substantial fraction of the billions of dollars earmarked for the program.
Some of the fines and settlements in cases against big pharma have been enormous. Between 2000 and 2003, according to Michael Loucks, chief of the Health Care Fraud Unit in the U.S. Attorney's Office for the District of Massachusetts, eight companies paid out a total of $2.2 billion in fines and settlements. | | Nothing demonstrated that influence more plainly than the prescription drug benefit added to Medicare in late 2003.1 You will remember that Medicare originally didn't pay for outpatient prescription drugs because when the program was created, in 1965, there was not much need for such a benefit. People didn't take nearly as many prescription drugs back then, and the drugs they did take were much less expensive. But now, senior citizens often take five or six drugs a day, at a cost of thousands of dollars a year out of pocket. | | The Medicare prescription drug benefit enacted in 2003, and scheduled to go into effect in 2006, promises a windfall for big pharma since it prohibits the government from negotiating prices. The immediate jump in pharmaceutical stock prices after the bill passed indicated that the industry and investors were well aware of the windfall. But at best, this legislation will be only a temporary boost for the industry. As costs rise, Congress will have to reconsider its industry-friendly decision to allow drug companies to set their own prices, no questions asked. More about that later. | | At the end of 2003, Congress passed a Medicare reform bill that included a prescription drug benefit scheduled to begin in 2006, but as we will see later, its benefits are inadequate to begin with and will quickly be overtaken by rising prices and administrative costs.
For obvious reasons, senior citizens tend to need more prescription drugs than younger people—mainly for chronic conditions like arthritis, diabetes, high blood pressure, and elevated cholesterol. In 2001, nearly one in four seniors reported skipping doses or leaving prescriptions unfilled because of the cost. | | For that reason, no one thought it necessary to include an outpatient prescription drug benefit in the program. In those days, senior citizens could generally afford to buy whatever drugs they needed out of pocket. Approximately half to two-thirds of seniors have supplementary insurance that partly covers prescription drugs, but that percentage is dropping as employers and insurers decide it is a losing proposition for them. | | Later in 2003, there was considerable pressure to permit drug importation from Canada as a part of the Medicare prescription drug benefit, but Congress resisted it and stayed true to big pharma by keeping the requirement for Department of Health and Human Services certification of safety. It did, however, call for the matter to be studied, which opens the door a crack.
Congress would like nothing better than to have this issue go away so it doesn't have to choose between voters and the pharmaceutical industry, but that is not going to happen. | Donald L. Barlett and James B. Steele See book keywords and concepts | In the fall of that year, when Congress enacted a Medicare prescription drug benefit for the first time, the White House point man on the half-trillion-dollar-plus taxpayer-funded program was Thomas A. Scully, administrator for the federal Centers for Medicare and Medicaid Services (CMS).
Before he became Medicare's top official, Scully was president of the Federation of American Hospitals, a 1,700-member trade association of for-profit hospitals "dedicated to a market-driven philosophy." Its business plan, it should be noted, depends heavily on federal tax dollars for Medicare patients. | J.D. Kleinke See book keywords and concepts | Together, they engineered a new kind of health insurance organization that owned or controlled its own doctors and hospitals, required no deductibles (called first-dollar coverage), emphasized preventive and wellness care, and offered an unusually generous and easy-to-access prescription drug benefit. In a political compromise to counter the left-wing push for nationalized medicine along these same lines, President Nixon sanctioned their creation, signing the HMO Act of 1973, and paving the way for the modern-day MCO. According to colleagues who were involved in those first MCOs (Dr. | Bob LeBow, M.D., M.P.H. See book keywords and concepts | He advised against adding a prescription drug benefit to Medicare— "not unless you are prepared to make fundamental changes in the way Americans finance the cost of their health care." He went on to assert:
"Beginning with a universal entitlement does not mean higher spending or more governmental interference with the choices made by patients or providers. In truth, it could mean a lot less of both. |
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