first-ever Medicare prescription-drug benefit

[Neil D]

President Bush kicked off yesterday what he called a "massive" nationwide outreach to millions of seniors to make sure they are enrolled for the first-ever Medicare prescription-drug benefit that begins in January.

Seniors can apply between Nov. 15 and May 15. Various local groups and volunteers will help with the process, from explanation to application. Those who enroll by the end of the year will be covered beginning Jan. 1.

Taking It Personally

Bush, who takes to the road today to carry the message to Maple Grove, Minn., said he is personally spearheading the 11-month education effort because he is worried that those low-income seniors who most need coverage might not get it. He said he is concerned that potential beneficiaries may be confused by the forms or unaware of the benefits and how to apply for them.

The outreach effort is a response to criticism from AARP and some Democrats that the administration flopped badly in getting a temporary drug-discount card program for seniors off the ground in the past year.

Bush promised seniors prescription-drug coverage in his 2000 campaign, and he made the program a major priority when he prodded Congress to pass it in 2003. Offering the benefits will cost US$500 billion in its first eight years and $700 billion over 10 years, program officials estimate. The original 10-year cost estimate was $395 billion.

Rep. Charles Rangel, D-N.Y., told House Republicans last year, "You would have not had the votes to pass this bill if the true cost of the bill was known."

Bush has enlisted federal, state and local government agencies along with faith-based and community groups such as Catholic Charities and AARP to partner in the program and help spread the word.

'Good Deal'

"This is a good deal, and people need to take advantage of it," Bush said in his kickoff speech delivered at the U.S. Department of Health and Human Services, which administers Medicare.

Fewer people than expected have signed up for the cards, and there were complaints the paperwork was too complicated and the many options too confusing.

Mark McClellan, director of the Centers for Medicare and Medicaid Services, said the administration has "learned from our experience" and pledged to get the new program off to a smoother start.

Bush said seniors will receive in the mail in October a handbook from Medicare explaining the drug options along with a four-page application for benefits. He said no financial documents or complicated records will be required. "Over the next 11 months," Bush said, "we will work to ensure that every American on Medicare is ready to make a confident choice about prescription-drug coverage."

Medicare Shortfall

Medicare, in its current form, does not cover prescription drugs for seniors. The new program changes that. Medicare beneficiaries will be offered a range of prescription-drug plans to choose from. Costs will vary depending on the type of plan and the income of the recipient. Most beneficiaries will have 95 percent of the drug costs covered once they spend $3,600 of their own money in a year. Most will pay a monthly premium of about $37, a $250 deductible and a share of their drug costs. Seniors who have other prescription-drug coverage can keep it and not participate in the program.

Low-income seniors, about one-third of the total, will be eligible for a drug benefit without premiums or deductibles, and more than 95 percent of their drug bills will be covered.

[Dr. Shane]

Are Democrats complaining this program is going to cost too much money?

I understand that Republicans complain of that. As do I. With Social Security and Medicare facing a future crisis, I didn't understand why Bush went down this road. To me, it seemed like pandering to get the senior vote for re-election. He certainly broke away from conservatives in his party by doing it.

I don't know what the answer is. I like HSAs (Health Savings Accounts) because they will make healthcare providers compete in the marketplace and healthcare consumers realize the cost of the services they consume. An HSA is an account where an employee can put tax-exempt income and his or her employer can match if they want to offer that benefit. They normally have a high deductible health insurance policy ($5-$10K) with them. Of course that doesn't do much for seniors - except help drive costs down.

[K]

Shane,

I have such a benefit program with my employer. If I could afford to, I can take pretax dollars and put them in an account to cover prescriptions, copays, and any out of pocket medical expenses.

The problem for seniors is the same as it is for me. It is very hard for me to save money for drugs and doctor visits. I just deal with them as I need to and that is pretty much how seniors are dealing with their prescription and medical bills.

I know that it all sounds good on paper Shane; but if the truth would be known, nobody can save for a hospital visit. Oh maybe the very rich, but the average person can't do it. Do you know what and MRI or CT or a set of XRAYS cost in the ER? A friend of mine went to my hospital with abdominal pain. She was there 10 hours, they ran every test known to mankind, and the diagnosis was some virus she must have picked up on a spring break trip to Mexico. The cost of the visit $6000.00.

It is a diffult problem, and I really am unsure of the best way to deal with a society that wants the latest and greatest medical technology at a low cost.

K

[Dr. Shane]

The problem with what your employer offers is that it is still insurance-driven rather than market-driven. It only involves deductables and co-pays. Insurnace-driven programs remove the consumer from the cost. When the consumer pays directly for the products and services he or she becomes more selective and thus creates compitition in the marketplace. Look how many consumers compare gas prices or even the prices at beauty salons. In Mexico many clinics have the prices of their services posted up front on a type of menu board.

A market-driven HSA will have an insurance policy that doesn't kick in until after $5k- $10k of medical bills have accumlated within a year. With the average American earning over $33K/year most can afford $50/week for their HSA (especially since most insurance policies are much more expensive). That would amount to $2,600/year. If this was started in one's early 20s or just after college, it wouldn't take long for a nice nest egg to be built. When all medical bills under the $5k-$10k are paid for from this nest egg the helathcare industry will become market-driven. That will drive down prices and help everyone.

Your firend's example illistrates two things: the first is a lawsuits-gone-wild state that has forced doctors to practice defensive medicine. Had your friend been treated in Mexico it would have cost her less than $100 to be diagnosed. The second is the insurance-driven healthcare system. I doubt your friend was informed of the costs of the tests before she recieved them or if she "shopped" around for better pricing.

[K]

Shane,

About my friend with the huge ER bill first. . . when you are doubled over in pain, you don't shop around for the best price. You go to the nearest emergency room, and you get treatment. Doctors treat illness where I work, regardless of you having insurance or not having insurance, which is one reason I like working at this hospital.

There is a lot of overhead built into the charges in a hospital bill, and it is the reason a couple of tylenol cost as much as a whole bottle. Do you realize that the they have a computerized machine called a pixis where they can get a lot of drugs without waiting for pharmacy. It costs $100,000 a month to rent that baby, and I can't count how many there are in the hospital.

MRI's, CT's, Ultrasounds, XRAYS, and all that stuff would eat up your whole medical saving in one visit.

All the equipment and technology drives the costs way up because we want it all done Shane. We want to do open heart surgery on 85 year olds. Open heart surgery is very expensive, but we want the best treatment no matter what and we don't want to pay the price for all that stuff.

I know many people who go to Mexico for treatment. There are many American doctors practicing just over the border. They don't have any regulations, and they don't have to have to worry about lawsuits over there. Yet Shane, my hospital, gets the wealthiest patients out of Mexico coming here and paying cash to get all kinds of treatment. They pay big bucks to get care in the US. I think it is ironic that they come here because of the technology, and we go there because ????????

K

[Dr. Shane]

Sister K, you replied so quickly to my post it seems you hardly had time to consider what I said. Let me try an make it clearer.

You seem to be stuck in the insurance-driven mindset. Your points are somewhat valid if the healthcare market remains insurance-driven. Personally I am not against universial healthcare although I think it would be better if ran by individual states rather than the federal government. However it is not very realistic. I don't see any form of universal healthcare happening in the foreseeable future.

The next best alternative is HSAs. In fact, HSAs have some things better than universial healthcare. Principally individual responsibility.

If and when a large number of Americans hold HSAs (which is very likely since they are affordable for small businesses) the healthcare industry will go from insurance-driven to marketplace-driven. That means night clinics will be open for your friend so she can avoid emergency room costs. It also means doctors will not be so quick to run tests that may not be nessasary.

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when you are doubled over in pain, you don't shop around for the best price.

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You may not shop around but you are going to insist on being treated fairly. It is no secret that ERs price gouge (as do pharmacutical companies). That practice would come to a halt.

Let's look at a real life example of the marketplace and emergencies. Say your car breaks down on the highway and the hiway patrol stops and calls a tow truck. Are you going to let him tow your car without asking the price? If he tells you the cost will be $500 are you going to agree simply because it needs to be done or are you going to insist on a fair price?

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MRI's, CT's, Ultrasounds, XRAYS, and all that stuff would eat up your whole medical saving in one visit.

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Not if the price was fair. You are thinking in the insurance-driven mindset not the marketplace mindset.

Say Jill is a waitress and marries Jack, a truckdriver. Jill is 23 and has been paying $30/week into her HSA since she was 18 and Jack is 25 and has been paying $50/week into his HSA since he was 20. Let's say they have spent 1/2 of thier HSAs on regular medical services. At the time of their marriage, both of them would have 5 years of paying into their HSAs. Having spent half of what they paid in, they would still have a combined $10,400 which would be enough to pay the deductable of the health insurance should anything sever happen. After only five years!

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All the equipment and technology drives the costs way up because we want it all done

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In a market-driven system there would be clinics with the latest and greatest technology and clinics without it, depending on how much a person wants to spend. In an insurance-driven system every clinic has the latest and greatest technology.

</font><blockquote><font class="small">Quote:</font><hr />

They pay big bucks to get care in the US. I think it is ironic that they come here because of the technology, and we go there because ????????

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That comment is quite insulting and nationalistic. All the technology availible in the US is available in Canada, UK, China, Russia and yes, Mexico. The US doesn't have any secret contraptions. Mexican doctors aren't stupid or unskilled. American doctors aren't the world's smartest. The difference is that not every Mexican doctor has the latest technology. Yet the latest technology is available in Mexico - just not from every doctor. Published medical journals keep doctors throughout the world informed on new procedures and treatments being done in other parts of the world. The reason many wealthy Mexicans come to the US for treatment is marketing and reputation. America has many skilled doctors and they market their services abroad.

[Dr. Shane]

Let me add this little bit of information.

Much, if not all, of the high-tech medical equipment that Mexico has is imported. The doctors have to pay not only the cost of the equipment but also the import taxes which can sometimes be as much or more than the cost. They must than charge high prices for the tests in order to recover the cost of the equipment and the import taxes. As a result it can be cheaper to just go to the States and have the tests done.

Loma Linda University donated a lot of used medical equipment to a Mexican hospital when they replaced it with new equipment. The Mexican hospital never was able to recieve the used equipment because they were unable to pay the import taxes.

[K]

Quote:

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[:"blue"] That comment is quite insulting and nationalistic. [/]

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Might be insulting, but it is true. We cater to these patients because they bring cash. We have 2 or 3 hired people to take care of their needs. We go out of our way to please them, and they come for everything. They could pay a lot less in their country, but yet they come. It ain't marketing it is services, skills, and toys.

K

[Dr. Shane]

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Might be insulting, but it is true.

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This is why America is hated abroad. So many here are just simply arrogant with no grasp of humility. The world wouldn't mind us exporting democracy if we were not so full of ourselves. When patritism becomes nationalism it is simply wrong.

Our doctors are human just like the rest on planet earth. They don't have superior intelligence. The technology they have is not exclusive to the US. Our wealth and capitalistic society does allow us to develope many drugs and technology first but it is quickly exported to the rest of the world.