Save Ourselves!
One of the more interesting dynamics to watch in the coming weeks will be the amount and intensity of Republican dissension over the Medicare Drug Benefit. Bush is great and all, but seniors actually vote, and faced with a Democratic tide, anxious congresscritters may try and preempt complaints over Medicare by doing the whining themselves. For those who voted for the bill, that'll prove a tricky needle to thread, but for those who weren't in Congress at the time, it's open season.
Take Mitt Romney, the stern-jawed Mormon in charge of Massachusetts. He's got a universal coverage scheme for the Commonwealth that he wants to make the foundational achievement for his presidential campaign. It's the sort of accomplishment that'll help the media ease him into the Governor Who Solves Things slot, an essential role in every presidential primary drama. But it's a little tricky to run as Hippocrates' second coming when your party just ruined Medicare. Which is why, for Romney, the distancing has already begun. Historically, major policies that become electoral liabilities don't survive for very long. Politicians almost always choose their survival over the policy's perpetuation. If the GOP's crop of 2008 contenders are already claiming this was the wrong bill, it becomes a bit hard to envision how Part D survives 2006, much less 2008 when the presidential hopefuls all decide repealing it plays well in nursing homes.
Comments (16)
So do the Democrats have any ideas for improving this bill? Or are they (once again) waiting for the Republicans to set the agenda so they can argue against whatever the Republicans come up with? Why hasn't the Democratic leadership made a big announcement introducing their new Medicare bill to the American people? What are they waiting for?
January 27, 2006 12:53 PM | Reply | Permalink
You can't just repeal it. Many private insurers have terminated the drug coverage portions of their policies, including Medi-Gap policies.
Many insured persons have canceled private drug coverage, because they became eligible for Part D. Those people with preexisting conditions will not be able to satify underwriters in order to get a new policy.
You can amend it, but you can't repeal it.
January 27, 2006 1:06 PM | Reply | Permalink
Good point about not repealing the bill--the Democrats' proposal must be about correcting the flaws in the current Medicare Part D plan, not getting rid of the coverage altogether.
The Democrats should move fast, however. A bill should be introduced--with great fanfare--within a week. Believe me, if the Democrats delay, the Republicans will be leading the charge and may actually start to look like the good guys to most Americans. I expect the Republicans to introduce some proposal within a week or two.
January 27, 2006 1:13 PM | Reply | Permalink
Determine the drugs that will be covered.
Have the United States government negotiate prices lower than Canada and Europe.
Let anyone with a Medicare or Medicaid "card" (or whatever proves eligibility) go to the pharmacy of their choice with their perscription and get the drug at the low price.
January 27, 2006 3:33 PM | Reply | Permalink
So the Dems should just offer to repeal it and simply add a list of covered drugs to Medicare (Part B, I think), and negotiate lower prices. This is what the Dems originally wanted, IIRC. It will sound very sensible and appealing, after the debacle of part D. The R's will try to say it is too expensive, but I'm willing to bet it isn't more expensive than the final figures for Part D. The R's will say they can't just repeal part D because of all the reliance so far. They will sound like obstructionists. They won't have an answer. But the Dems will. The problem will come in 2007, but by then someone will figure out how to do a transition, maybe as part of a move towards universal coverage.
The R's propose things all the time they know won't work--why can't the Dems propose something that will work if we can get to it?
January 27, 2006 3:41 PM | Reply | Permalink
Democrats should come out for government negotiated prices and if the Republicans respond that this will result in drastic reductions in research ask them why they supported drastic reductions in NIH funded research. Fund research not high prices.
January 27, 2006 3:50 PM | Reply | Permalink
The number one problem for the poor and fixed income people will be the donut. Can we get rid of that ? Also can we set a standard co-pay for generics ( or get rid of them all together )
January 27, 2006 4:15 PM | Reply | Permalink
Hey, what makes you liberals think the richest country on earth can buy pills for all those freeloading retirees??
If they want drugs why can' they pay someone to buy the drugs for them like Rush Limbaugh? He supports his own drug consumption by shucking money off right-wing dittoheads, why can't liberals do the same?
January 27, 2006 5:10 PM | Reply | Permalink
Hardball:
1. Repeal all recent extensions of drug patents and, in fact, shrink durg patents to 10 years.
2. Require an FDA determination of substantial difference in benefit for a variant drug to receive a new paptent.
3. Mandate that any drug that results from any partial federal funded research is patented to the HHS, with no intellectual property profit going to any other entity.
4. Substantially increase federal funding of drug research.
5. Decare the patent of any drug not manufactured and distributed to a degree matching public health need as abandoned.
6. Having sliced off the pharmaceutical industry's b***s, demand that drugs be sold on a cost + basis, with a modest profit margin allowed. Permit only 5% profit on intellectual property, for direct costs only. Pay no more.
Cut out the insurance companies and manage this thing directly by Medicaid and Medicare.
Cover all effective drugs.
Set a premium that matches the coverage, DO NOT SHIFT TO THE WORKING POPULATION, unless you are going to surcharge for the higher income working populaiton.
January 27, 2006 7:20 PM | Reply | Permalink
The posts here are right on. The prescription drug bill basically changed the healthcare and insurance industries in ways we don't quite understand yet. It can't simply be reversed.
But... it's not popular and though it was billed as some sort of hand-out, it's so confusing that even the people who are supposedly getting some charity from the government can't seem to deal with it.
I'm not sure how to do this, but it seems that if there's a prevailing complaint about it, it's a complaint about complexity. It needs to be simplified in order to gain wider acceptance. Might be easy to argue, perhaps a bit mutteringly, that this current system was meant to offer people what they deserve but made so complex that they can't get their due...
January 27, 2006 9:41 PM | Reply | Permalink
Anybody who watches TV these days is being bombarded by ads for prescription drugs. That's where our drug dollars are going, not to research. If Democrats point this out forcefully, then all those commercials become OUR commercials -- they prove our point.
The ultimate Democratic goal has to be a single payer healthcare system. America already spends more on healthcare than any other country, no matter how you slice it: percent of GDP, per capita, whatever. And we get crummy results: Life expectancy is higher in Canada, where they spend less.
The total bill for American healthcare is something like $1.7 trillion. That's plenty of money to cover all Americans -- if only we could spend it treating patients and doing research. Instead, the market wastes it on advertising, corporate profits, and bloated executive salaries.
The Republican healthcare idea -- more market competition -- will make everything worse. Corporations will compete by advertising more, not by providing better service at lower prices.
January 28, 2006 7:28 AM | Reply | Permalink
Its the only intelligent solution to this problem. Okay, when Clinton introduced single payer, it was easy to ridicule. But that was before millions of workers lost their benefits, then lost their jobs. That was before some of the biggest employers began to renege on their pensions little by little before defaulting on them entirely. That was before some of the biggest employers decided to forego all the trouble of defaulting, and just cancel pension plans. That was before Bushco announced the wanted to scrap Social Security and throw people on their own devices. That was before PHARMA bought Congress, pretty damn openly. Thank you Billy Tauzin.
I don't know about most of you, but as a professional earning about 50K, with health and retirement, I'm the exception in my extended working class family. I'm not quite in the two or three paychecks away from totally losing it all, but as a man in my early fifties that had a double bypass at 47, I could easily be.
We have the best health-care technology in the world, and the worst health-care delivery system. We've known this forever, and yet every year more people in every age range die from or suffer debilitating illnesses and conditions while they pass in front of the big medical centers and HMO palaces that make people like the Frists super-rich and getting richer every year.
Its like those teen slasher movies. Why can't they see what is happening all around them?
Why can't we?
January 28, 2006 8:36 AM | Reply | Permalink
The donut's there to keep the price down. The only way to fix is to take out the middlemen--the insurance companies, and negotiate lower prices. Universal coverage for seniors, even in this scenario may still be more expensive, but keeping the bill as is, and eliminating the donut will cost a fortune.
If the Democrats can't use this enormously failed policy to illustrate the republican inability to govern and complete fealty to their corporate "contributers" then they don't deserve to win.
This should be especially fertile ground for potential freshman congressmen. It shows the wisdom of Dean's focus on running in every race. Angry elderly voters in a mid term election may put into play some surprising seats.
January 28, 2006 10:47 AM | Reply | Permalink
Okay, when Clinton introduced single payer, it was easy to ridicule.
I actually read that health care plan. It didn't introduce single payer. It gave states an option between choosing a single payer plan or adopting a complex, overlapping set of insurance companies and oversight commissions to manage health care. I think the intent was to make the single payer plan the no-brainer choice of the two for state legislatures. But, in fact, the focus was on the byzantine alternative. If they'd just stood up, and advocated a single payer plan by state, they would have lost, but that would be on the table as an alternative.
Cutting out insurance companies is gonna be very difficult. This is gonna have to be done in stages.
January 29, 2006 7:03 AM | Reply | Permalink
I could use some help here. I don't understand why we are not all clamoring for universal health coverage as described by Paul Krugman and reported to the blogosphere by Brad Delong here.
The model of the Veterans Health Administration seems to be an excellent solution, or at least a well defined and workable (working) starting point which defeats any number of questions of socialized medicine, goverment bureaucracy, care quality or ineffeciency.
"The dissonance between the dominant ideology and the realities of health care is one reason the Medicare drug legislation looks as if someone went down a checklist of things the veterans' system does right, and in each case did the opposite..."
So why aren't we all over this???
January 29, 2006 11:33 AM | Reply | Permalink
Another possible approach is to require that and independent actuary evaluate each package in each state and that Congressmen and Senators for each state have their Congressional health care coverage replaced by the WORST plan in that state.
January 29, 2006 7:41 PM | Reply | Permalink