Senate OKs Sweeping Overhaul of Medicare; start of all HMOs

[Guest guest]

>

>

> Senate OKs Sweeping Overhaul of Medicare

> By James Gerstenzang

> Los Angeles Times

>

> Tuesday 25 November 2003

>

> WASHINGTON -- The Senate voted today to make the most sweeping

changes

> in Medicare since the health-care program for senior citizens and disabled

> Americans was established in 1965. By a vote of 54 to 44, it approved a

> bill adding a prescription drug benefit and encouraging a greater role for

> private managed-care plans.

>

> President Bush, who is likely to use the measure as a centerpiece in

> the domestic-policy component of his reelection campaign, said: " This is a

> good bill and I'm looking forward to signing it. "

>

> The House approved the nearly $400-billion measure after an

> extraordinary three-hour vote Saturday morning.

>

> Critics of the measure complained that it provided insufficient

> coverage, began moving the program toward greater private control, was a

> boon to the health-care and insurance industries, and cost too much. Its

> supporters praised it as a necessary step, although less than perfect,

> toward helping Medicare beneficiaries meet the escalating costs of

> prescription drugs, which are playing a far greater role in medical care

> than when the program was developed at the heart of the Great Society era.

>

> The two days of rancorous Senate debate, capping months of on-again,

> off-again private negotiations and public pressures, brought to the fore

> the arguments over Medicare's course in the future, and, indeed, the

course

> of health care in the United States.

>

> Senate Majority Leader Bill Frist (R-Tenn.), who was a heart surgeon

> before his election to the Senate, said that the elderly " will finally

have

> the prescription drug coverage they need and the choices they deserve. "

>

> He said that the measure would, at the same time, preserve

traditional

> Medicare.

>

> Sen. Edward M. Kennedy (D-Mass.), who as a freshman senator supported

> the Medicare program as it was being developed, said the changes would

> leave the program's beneficiaries " in the cold arms of the HMOs. "

>

> Speaking shortly after the vote to doctors, administrators and local

> officials at a hospital on the outskirts of Las Vegas, Bush said passage

of

> the Medicare bill was a " major victory to improve the health care system

in

> America. "

>

> In remarks emphasizing a continued role for Medicare in meeting the

> health needs of the elderly and disabled-an apparent recognition of

> concerns about the programs future raised by critics of the measure, Bush

> declared:

>

> " The Medicare system is a central commitment of the federal

government

> It's a basic trust that has been upheld throughout the generations. We're

> keeping that trust. "

>

> In a flurry of post-vote commentary, Democrats, Republicans and a

> multitude of interest groups sought one more time to make their arguments

> at the center of a debate that is only likely to pick up in volume as the

> 2004 political campaigns grow.

>

> " Many seniors already understand what a betrayal this is and they're

> furious, " said Senate Minority Leader Tom Daschle (D-S.D.)

>

> House Speaker J. Dennis Hastert (R-Ill.) emphasized the plan had

> developed at last some bipartisan support and said it was " the most

> significant enhancement to Medicare since its creation four decades ago

> because it changes our health care delivery system for the better for

> today's seniors, tomorrow's baby boomers and future generations. "

>

> But public opinion appears split, according to the University of

> Pennsylvania's National Annenberg Election Survey.

>

> The survey, polling 860 adults last Wednesday through Sunday, found

> 40% favoring the bill, 42% opposed, and the others with no opinion. But,

> the survey found, those 65 and older, opposed the measure by a margin of

> 49% to 33%.

>

> Democrats who opposed the Medicare changes had sought to delay the

> vote, hoping that as more attention was brought to the shifts it would

make

> in Medicare, opposition would grow, particularly among the elderly who

> depend on it to meet the costs of health care. They have presented it as a

> measure benefiting primarily the pharmaceutical and insurance industries,

> rather than recipients of Medicare.

>

> The debate is likely to spill over into the political arena

throughout

> 2004, and could well become an underpinning of the presidential contest

and

> campaigns for the House and Senate.

>

> " The Senate is on trial, " Kennedy said. " Let us not turn our backs on

> our senior citizens so insurance companies and pharmaceutical companies

can

> charge senior citizens even higher prices. "

>

> He said Monday that passage of the measure " starts the unraveling of

> the Medicare system. "

>

> Sen. John F. Kerry, also of Massachusetts and a Democratic

> presidential candidate, said: " This bill is really about President Bush

> passing the buck on prescription drug coverage and passing the bucks from

> seniors to the pharmaceutical industry. "

>

> Two other candidates, Sen. John Edwards of North Carolina and Sen.

> Joseph I. Lieberman of Connecticut, joined Kennedy in expressing

opposition

> to the measure.

>

> At the center of the legislation is an optional prescription drug

> benefit for most seniors that would begin in 2006. For the first $2,250 in

> drug costs each year, Medicare would pay 75% after a $250 deductible. Then

> there would be a gap in coverage, with patients solely responsible for the

> next $2,850 in drug costs.

>

> Once seniors had paid $3,600 out of their own pockets, Medicare would

> cover 95% of the cost of subsequent prescriptions. The monthly premiums,

> starting at about $35, and annual deductibles would increase with

inflation.

>

> In addition, the bill would set aside more than $14 billion in

> payments and risk-sharing for health maintenance organizations and

> preferred-provider organizations.

>

> The funds are intended to encourage managed-care plans to participate

> in Medicare and to help them offer better benefits packages at lower costs

> than the traditional fee-for-service program Medicare offers. Starting in

> 2010, pilot programs in six areas would allow managed-care plans to

compete

> with the current program.

>

> For the more than 4 million retirees who have supplemental health

> coverage through their unions or former employers, the drug benefits they

> receive are more generous than the Medicare benefit. To encourage

employers

> to maintain that coverage, the bill includes more than $71 billion in

> subsidies.

>

> Other groups that stand to benefit from the Medicare bill include

> private insurance companies and health plans, which would have access to

> $14 billion in subsidies and risk-sharing payments from the government;

> rural hospitals and doctors, which would receive some $25 billion in

> additional payments; and hospitals that treat large numbers of illegal

> immigrants in their emergency rooms. They would receive an additional $1

> billion over 10 years.

>

> In addition, the bill would allow Americans of all ages with

> high-deductible health insurance policies to bank thousands of dollars

each

> year in tax-sheltered health savings accounts. Health-related withdrawals

> would also be tax-free.

>

>

> ----------

> <http://www.sltrib.com/2003/Nov/11242003/opinion/113998.asp>Go to

> Original

>

> Bad Medicine

> Salt Lake Tribune | Editorial

>

> Monday 24 November 2003

>

> Big drug companies and private insurers with billions in profits at

> stake will benefit more than the elderly if the U.S. Senate goes along

with

> the Republican plan that narrowly passed the House at dawn Saturday to

> expand Medicare to help seniors pay for prescription drugs.

>

> The elderly, especially the very poor, desperately need help to pay for

> medicine. The bill that squeezed through the House by a 220-215 vote

offers

> some relief, but it also gives pharmaceutical companies a nearly free rein

> to fleece taxpayers with exorbitantly priced drugs.

>

> The bill would provide 40 million elderly and disabled Medicare

> beneficiaries a government subsidy to purchase private insurance to help

> pay for prescription drugs. It provides about $86 billion to encourage

> employers to keep retirees in employer drug plans and $12 billion to

> encourage preferred provider organizations to give Medicare-subsidized

> coverage to seniors.

>

> The catch, though, is that the bill gives big drug makers a protected

> market but fails to place curbs on pricing.

>

> A provision that would have allowed seniors to buy drugs from Canada,

> where they are substantially cheaper, was removed from the bill. That

means

> Medicare beneficiaries will be forced to pay, and taxpayers to subsidize,

> whatever prices the drug companies charge.

>

> The bill does have some pluses besides helping seniors pay drug

bills.

> For the first time since Medicare started in 1968, beneficiaries with

> higher incomes would pay higher premiums for their doctor coverage. It

> includes $25 billion to close the gap in Medicare reimbursement rates

> between urban and rural hospitals and give rural doctors higher

payments --

> a provision that would help Utah's low-income rural Medicare patients.

>

> Nevertheless, the bill would cost taxpayers at least $400 billion

over

> 10 years, an expense the country can ill afford in a time of huge deficits

> and the continuing conflict in Iraq. The daunting expense is even harder

to

> justify when more than 41 million Americans, including many young families

> and children, have no health insurance at all.

>

> Picking up the tab for high-priced medicines will force the deficit

> even higher over the coming decade. If the Bush tax cuts become permanent,

> the nonpartisan Congressional Budget Office projects annual deficits of at

> least $150 billion through 2013.

>

> Along with those concerns, some opponents of the bill are rightly

> worried about a plan to establish six test projects where the traditional

> Medicare program would compete with private insurers. In the past, such

> privatization, in the form of Medicare HMOs, has led to higher premiums.

>

> There is no doubt that seniors, especially those on limited incomes,

> need help to pay for drugs. But expanded Medicare should be approved only

> if it is combined with measures to cut the cost of drugs and rescind the

> Bush tax cuts.

>

> http://www.truthout.org/docs_03/112603A.shtml

>