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Soon the mind is blank and all are in a trance

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By Wendy Binnie

The New England Journal of Medicine is of the opinion that most Americans agree that affordable drug coverage under Medicare has been needed for some time. But instead of a solution to a growing problem, Congress gave the country a prescription-drug plan that achieved few of its original goals.

The current problems with Medicare Part D are largely the direct result of the undemocratic way in which the plan was authored and passed. The final legislation, heavily influenced by drug-company and health insurance lobbyists, focused mainly on the needs of those industries instead of those of the seniors it should serve.

The political process used to pass Part D was the worst abuse of the legislative process in many years. In the months before its passage, a few powerful Republican leaders worked to undermine conscientious reform proposals. In early 2003, while the House bill was being drafted, Democrats and Republicans authored 59 sensible amendments to it. At the behest of the Republican leadership, however, the House Committee on Rules rejected all but one, preventing them from being debated by Congress. Many of those amendments — among them, one requiring the administration to use beneficiaries’ collective purchasing power to negotiate lower prices, and one allowing Americans to import cheaper drugs from Canada — would have made the legislation far more effective and probably would have received bipartisan support, had they been allowed onto the floor.

Health and Human Services has refused to certify Canadian drugs for prescriptions, even though they are the same drugs, made by the same companies, to the same standards. However, the previous administration did promise to conduct a study into the matter. Naturally it has not been heard from. Bryan Zepp Jamieson wrote that “it sounds confusing as all get-out. Medicare will pay 75 percent after $250 has been spent, up to $2,250. After that, there’s a ‘window’ in the coverage that extends all the way to $5,100. Patient pays 100 percent. Then Medicare kicks back in, paying 95 percent of costs over $5,100. Until the end of the year. Then you get to start over.” Quite obviously the confusion is there for a purpose. The Republican designers of this monster wanted folks on Medicare to be staring helplessly at their calculators, wondering where to begin. “It’s actually real simple: If you rack up $5,100 in prescription costs in a calendar year, Medicare will pay only $1,500 of that, leaving you to manage the remaining $3,600.”  Of course you’ll start the New Year with the same deductibles. Oh, and they want you to pay $420 a year for the privilege, so each year, on $5,100 worth of drugs, you shell out a total of $4,020. “If you only make about $40,000 a year or less, it means — what’s a delicate word for screwed?” In fact, you’re screwed anyway. A couple of real nasty provisions were slipped in there.

First, the government agrees to end all efforts to regulate the prices of prescription drugs. No price caps, no regulation. And why not? After the first $5,100, the taxpayer is footing the bill! The drug companies will work hard to get you to cough up handsomely for this wonderful gift. There’s a new program that pays $1,500 on the first $5,100 in prescription drug costs. That’s really going to help the fixed-income folks, isn’t it? Costs about $425 a year, so in reality, they shell out a tad over $4,000 for drugs that cost $5,100 without any coverage at all. The deductibles will continue to climb every year – what was that about socialism when universal health care is discussed? Oh, when the rich get goodies it’s not socialism, it’s business. By 2011 the 95 percent coverage doesn’t kick in until the $8,500 level, with only about $2,250 of that covered by Medicare, at an additional cost of $700 a year. “In other words, once the drug companies get done jacking their rates (and who’s gonna stop them?) you’ll pay $700 a year for the privilege of paying $7,250 for drugs that cost $5,100 now.” As part of this deal, Congress’ half-hearted efforts to regulate drug prices were dropped, and it remains illegal to get the same drugs at a much lower price from Canada! Nearly 70 percent of AARP’s members feel scammed and also betrayed by The American Association for Retired People.

Has anyone read the low-income provisions? Premiums, deductibles and coverage gaps will be waived for people earning less than $12,123 a year. To qualify for the subsidy, seniors can have no more than $6,000 in assets, other than a house. The subsidies will be phased out between $12,123 and roughly $13,500 in yearly income. “Most people have at least $6,000 in furniture, car, and clothing. And of course, if you make $13,500 a year (a princely sum indeed) and own a late-model Buick, you don’t get any of it.” The same people who whine endlessly about having to pay 20 percent taxes on an income of $1 million a year have decided that making $13,500 means you don’t need any help. After digesting this bit of government largesse don’t the screeches of socialism as applied to health care for all fall rather flat?

It costs Medicare about 3 percent in administrative overhead – why can’t the same people manage health care for all? (It costs 31 percent on the insurance company books.) The whole megillah reminds one of a song from Camelot: ‘What Do the Simple Folk Do?’ According to Arthur and Guinevere they whistle, they sing and they

dance. ‘They whirl ‘til they’re completely uncontrolled. Soon the mind is blank and all are in a trance.’ Sounds familiar; but at least Arthur and his Lady actually cared what the simple folk, who make their carefree existence possible, did. Do our leaders?

As I was saying …

Wendy England Binnie a novelist and op/ed columnist lives in Oak Trace Villas.