Medicare; Another Boosh Fiasco
From Iraq to Social to Security to Katrina to Abramoff, and everything in between, we now have the Disaster of Medicare. This is no surprise, we all knew it was coming. If Booshco created it, it's going to be screwed up, and we've learned to live with that fact. I have talked to insurance representatives, pharmacists, and people trying to enroll or participate in this "great new program." Without exception, they have all told me the same things. It is too complicated for the average Rhodes Scholar to figure out. It has become such a fiasco that many states have declared public health emergencies, and Boosh has told insurers that they must provide a 30 day supply of medication of any drug that a "beneficiary" was previously taking, and that they may not charge more than $5 for each prescription.
Why is this important? Well, for one, it's important to the people who need the medication. Secondly, it shows just what a disaster this program is. When does a pattern of incompetence become too much? With Booshco, apparently never.
Some folks that signed up for this plan in November and December and attempted to use it after it "went live" on Jan. 1, have been told that they must first satisfy a deductible that ranges from $100-$250. Money that these folks don't have. So, they have not received their medications. Others have been told that they were not enrolled in the program at all, showing that the federal government, the group that heads this mess, has no clue who is actually enrolled and who isn't. Pharmacists have been calling insurance companies who have no answers, insurance companies have been calling the federal Centers for Medicare and Medicaid Services, who in Booshlike fashion have been telling them that "all is well," and the Boosh administration is saying that they are rushing to provide insurers with correct information about the subsidies available to low-income people enrolled in their plans. Rushing? Did we just create this program in late December?
No, we didn't. A State Farm Agent that I know quite well has told me that he has been studying this program for months, and still doesn't understand half of it. And, he's a pretty bright guy. Imagine the average low income "pill seeker" who was forced to choose between one of god knows how many programs that are available, those who simply need the medications that they have been taking for years. Forced to choose, yet not having been provided the information necessary to make an informed decision. They chose anyway, and most are leaving the pharmacy empty handed, and totally in the dark about what to do about the problem. Pharmacists don't understand this program, insurance providers don't understand it, patients don't understand it and I doubt that the geniuses that created it understand it.
Republican governor Tim Pawlenty of Minnesota said, "The new federal program is too complicated for many people to understand, and the implementation of the new program by the federal government has been awful." Yes, a Republican said this. Said it as he was signing an emergency order that makes his bankrupt state provide payment of out of pocket expenses for drugs for people without the money to pay. Other states are rapidly following suit, realizing that if they don't step in they will have a bunch of dead citizens on their hands, dead because they could not get the drugs that they have always gotten to stay alive. While the feds try to figure out how to fix yet another failure, the states, most of whom are operating deeply in the Red, are ordered by Boosh to pick up the slack. Katrina bells ringing anyone?
I realize that this is an unusual subject for Cyclone land, but I think it's important for a couple of reasons. First, nearly all of us have a relative or someone close to us that depends on these programs to stay healthy, even stay alive in some instances, or may need them ourselves. So, one way or another, it affects us all. Secondly, the fact that Boosh has botched another massive program that he promised would be a good deal to the American people is important. He has screwed up EVERYTHING that he has touched, clearly throughout his entire public life, and most things in his private life. Here is just another shining example of moronic policy.
Since the federal government can't seem to get a list together of people who have signed up for their new program, maybe they should devote a little more time and a lot more resources into doing so. Maybe putting less time and effort into reading the email of American citizens, less time listening to their phone converstations and spending less time tracking the American citizens every move on the internet, would allow for the poor to obtain medications that are desparately needed. Just a thought.
Cyclone
posted by cyclone @ 8:02 AM
20 comments
20 Comments:
Wow!! I get to be first for a change!
I have a son with Cerebral Palsey. It's hard form us, but it's REALLY hard for him! A lot of people don't think very much about being trapped in a wheelcair, but dig this! Every morning most of us get out of bed and walk to the bathroom. He never has!
In the last month I've been to my cousin, (a real esate attorney!) trying to figure out this crazy bullshit they have his medication on now! He was totaly at a loss! It says one thing in chapter 1 and something totally different in chapter 2. His social worker finally figured it out and got him enrolled and for right now his medication is coming in.
Now we're getting flack over how much some of the medicine costs! Didn't Boosh stand with Big Pharma to keep the government from getting the best price on drugs! Now they're squawking about it!
Cyclone
I have read someplace that the three main areas that really are making money are big Oil, pharmaceuticals and banking. Now this is another corporate gift as far as I can see. Booshco lets the wolves protect the chickens. We need some sort of competition among these entities. We need FDA to actually look out for us instead of corporate profits. The government needs to stop being for sale to the highest bidder. Now this crap has been going on for sometime and it really hasn’t been so obvious. Now that the crunch is on it is all to apparent to see that its not about protecting the interests of all, but its for a few that have money to purchase advantage in law making.
I was doing a job in KC a few years back and was talking a guy working that had become a son that became a Pharmacist for local pharmacy. He told me his son could buy the pills he needed for his heart at slightly above the pharmacy’s cost. The cost of the pills was $.05 each and do you have any idea what they were charging the general public for the pills, it was about $6.00 each. Now I don't mind people making money but this is just plain wrong. Granted everyone has overhead and should be able to charge for a fair margin of profit to sustain themselves, but it is unfair to have the government step in to allow out right gouging.
We had a news story last night that said a lot of mom and pop pharmacies were giving critical proscriptions to people who were not covered after the new medicare/medicade programs went into effect. They either couldn't afford the deductible or couldn’t figure out which program provider was best selection for them. Guess they want to thin us out by taking the people that are a drain on the countries benefits.
Stoney,
I have known about your son for a good while, but never thought about the direct connection with you and this ridiculous policy and administration. Gotta make sure us baby boomers don't cut into the profits as we age. Bastards. I don't know how you do it. I am truly sorry, but I know that he is in the best possible hands, as long as he has you to care for him.
Cyclone
Anonymous 1,
The Pharma industry is no different than the electronics industry in that the first X number of years you are paying for the R & D. Then, prices go down, at least in the electronics industry. The Pharma's have a built in excuse not to drop prices, that being losing the patent and letting generics take over. So, they bleed us as long as they have a patent. What disturbs me most is they gouge Americans, knowing that they will pay, while selling to other countries at lower prices, whatever the market will bear. The least fortunate American's are the ones that pay for this insanity, as usual. It's no different than tax cuts for the rich, the rich get richer and everybody else gets screwed. Soon, all but 1% of the American population will be in the "everybody else" category, and a whole lot of upper middle class American's will be putting bullets in their heads.
Cyclone
Anonymous 1,
I forgot to mention, population reduction may well be a part of the master plan, you are right about that.
Cyclone
Yup, so it is. I finally got to 65, and got the book outlining the benifits of the new medicare program. I went through it once, shook my head, and tried to get through it a second time. I compare it to the fedral tax code, I can't make heads or tails of it. I have no idea what to do about it. Local office a couple months ago said they were sending staff to school so they could explain it to people. Last I checked, they were as confused as I am.
Booscho does it again.
I agree with the population reduction theory. Poor people don't contribute to the bottom line of the mega-rich, so this plan might get "rid" of some "undesirables" in this society. I believe that Bushco see their roll as doing God's work -their mantra seems to be, "God made you poor so you have no business existing on the planet." Looks like Social Darwinism is alive and well and is being implemented whole-heartedly in this country.
Medicare has been a huge mess long before Bush tried to fix it, but he has gave this Part D prescription to his pharmaceutical buddies. And the actual code is such a mess.
There was the Balanced Budget Act (BBA "bubba" to us) but that had huge cuts and was also cracking down on the rampant fraud in Home health Agencies. Well the most dishonest or fraudulent (my opinion) cried to their senators. And I imagine other sectors that were also facing huge cuts called their senators. Home health agencies used to be paid for their costs, and these were little mom and pop organizations. They would have ghost employees usually relatives receiving large salaries. They would take trips. They would do lots and lots of things and ask Medicare to pay. The reason it was so lucrative is because HHA’s were paid on their cost and 99% of their business was with Medicare patients. They would accrue (include expenses ) in their books for expenses and be paid by Medicare; however they would not pay off these accruals. The many many HHA’s that went bankrupt is because they would be asked to pay back a million or two and could not do it.
After the cries to Congress, about these terrible cuts to HHA’s and others the Benefits Improvement Act of 2000 (BIPA) was voted in.. This reversed some of the cuts that had been implemented in the BBA of ’97. So what happens is there is a change in the code not a new replacement code. A band-aid on a band-aid; thus making for confusion.
Each year as budgets are approved or whatever Congress does toward Medicare then the ARRP or AMA or some other group squawks about the cuts and then Congress backs down.
The Interns and Resident program for Graduate Medical Education and the Indirect Medical Graduation is an example of one band-aid on top of a band-aid on top of many others. Creating mass confusion! This is the program in which under Part A Medicare hospitals with medical schools get paid for each full time equivalent intern (FTE) that is doing an internship there. This could be from 50-100K per FTE. Then in addition they get a huge add-on payment for the related indirect associated costs. The rationale behind this was that the interns would be running more tests and taking more time and resources. At any rate, a few years back Congress put a cap on these amounts. Now as part of the Medicare Modernization Act (which includes prescriptions Part D) they have allowed for increases and decreases in the cap based on hospitals that affiliate with each other. Essentially they have gotten rid of this cap, but effectively for the implementation of this it is so so so complicated.
I have seen one hospital in my state get a special exemption and law changed based on their individual need and the strength with which they convinced their congress man. The large medical school in this area has huge huge influence and power over this state.
Congress has no idea that these laws that the create are implementing by these band aid procedures. Nor do they look at the long term impact or say hey didn’t we just implement this cut and now we are essentially rescinding it without wording it as a recession.
Also a year or so back on 60 minutes was an episode about how E&Y and Arthur Anderson recommended to their rich clients certain tax shelters that weren’t really on the up and up. The show was about the IRS now issuing fines and back taxes from these rich clients. The accounting firms had no liability in this. This was a niche in which they made millions and millions.
In Medicare there is the same niche by lawyers and consulting firms that will find any gray area and any loophole in the system. Once a hospital receives full reimbursement from medicare, the provider will file an appeal. These paid consultants are ruthless and know very well that what they are fighting for is wrong, but there might be a loophole. They also make millions and work on commission of what funds they receive back from Medicare. We are still working on these cases from the early 90’s.
As it is clear with the Medicare Part D it is the same for DSH (disproportionate share hospitals) in which hospitals that serve a large number of Medicaid patients they will get paid extra money. In both of these cases there is a constant push and pull between state and federal of who pays. Currently the trend in the laws enacted by Congress are pushing these costs to Medicaid at the state level, which makes their medicare budget look good, but look what is happening at the state level. The prescriptions drug is the same thing. It is just switching who pays and now the feds are paying less.
So the band aids are the reason for the confusion.
When Congress knew the rest of this MMA law did not fix Medicare they should have worked on it until it was fixed instead of passing it for the Part D, but Bushco promised the pharmacies their big bucks. It is unbelievable that they can not use the same system that the VA using in buying their drugs. Clearly this was payment to the pharmaceutical companies.
I just could not believe that after this was passed that then Bush wanted to fix Social security.
Anyway, our health care system is also going to implode. Trauma centers will continue to close. I believe that 2 hospitals in New Orleans can not be restored or reopened. Where will these people go?
Working in reading the Medicare laws, and again I only work with one portion, it is a joke. And the Centers for Medicare and Medicaid Services (CMS) is ALWAYS on the provider side. My job is to ensure that the provider is adhering to the reporting regulations; however CMS doesn’t care about those and makes constant exceptions.
I’m really wondering what Scott McClellan could have done as the head of CMS (or Dept of Health and Human Services over CMS) to earn the position in Busco that he has. He must have been instrumental with the pharmacy lobbyists or something.
to lie in the service of God...
Like the rest of you, I've been touched by the Medicare drug benefit. My mother asked me to help her decide which way to go. So I had her assemble her prescription information and her last year's expenditures. And then I asked my sister, the insurance exec to take a look :-)
She threw up her hands. In this state, we have perhaps 70 different options, each with different drugs, different deductibles, different costs. I heard it was over 100 options in the state to the north.
In the end, my mom stayed with the drug plan she had. Did the Medicare drug benefit save her any money? Dunno, but probably not. I know it sure didn't save *me* any money.
One thing I wonder about often these days is the lack of *accountability* for our leadership. Nobody seems to be held responsible for all of the screwups and there have been some really monstrous ones lately.
Makes me think that 40% (latest Bush poll) of the country is operating with an entirely different worldview than I am. Here is a short, but interesing essay on the phenomenon:
http://www.mindfully.org/Reform/2005/Mass-Delusion-Neurobiology11jan05.htm
I wonder if a simple litmus test could be applied to filter out people with such a mindset:
"Do you believe that the [insert divinely-revealed scripture of choice in this space] is the literal and inerrant word of God?" If the answer is yes, then that person is not qualified to try and lead all of us out of this mess here on earth.
Peace to all of you,
-E
Here's that link it a more Blogger-friendly format.
http://tinyurl.com/7jzt2
Sorry about that.
-E
efsaturn,
Thanks for the well thought out post. You clearly have a lot more knowledge about this subject than I do. I would suspect, re: the McClellan issue rests more with his mother than anything he might have done. Just a guess, though.
Cyclone
emiliano,
I would feel a lot more comfortable if there were only 40% of those that you speak of. I fear that they were more. Thanks, as always, for your comments.
Cyclone
Murph,
I would say, after speaking to my insurance buddy, that they can send anybody and their mothers and no one will know any more than they knew before the little talk. It's a fricking disaster, like everything else.
Cyclone
Dude,
You are probably right on with this one. Less old people = more money for the boys to play with, for a little while longer anyway. They don't think it can end either. But, it always does.
Cyclone
Emiliano,
I took a look at the site you posted. Good analysis, worth reading. The effects are also termed social inertia.
Thanks for posting it.
Hi Cyclone,
This is actually in response to your email problems the other day. We did trade comments about being monitored a dew weeks ago.
So - here's an extension to your experiment. I'm flying cross-country next week, to get out of the dreary Eastern Winter for a few days to return to some of my former, and warmer, haunts out in the Arizona desert. I'm half way expecting to show up at Philly airport and find that I've been put on the no-fly list. If that turns out to be the case, I'll let you know, so everyone else who writes on your blog can know what to expect at the hands of our police state. I fly several times a year, and other than being asked to remove my shoes and getting wanded, I generally don't get bothered more than most other people. Now that I've been more vocal, let's see if that has changed.
On another note - given the location in which I live, I've got a ringside seat observing the struggles and despair that are befalling more and more of the common people in this country. I'd like to write a fairly extensive essay on that for you, but I'm consumed at the moment with some home repair projects I need to finish. But, it will be coming ...
RP,
If the dems don't take back the house after all of this, it's over. Period.
Cyclone
Carl,
Keep me posted. I hope you are not detained, but expect the worst. Can't wait for your views of the downtrodden. Stay safe,
Cyclone
This government does not give a ratz ass about the poor, the handicapped or the elderly. Just look at what happened and is still happening to the Katrina victims, look at how the have screwed up Medicare and how they are little little taking away things like financial aid for poor students. This government is all about the ALL MIGHTY DOLLAR and making the rich richer. Also eliminating the middle class and the poor and the old who appear to be a burden to our new self proclaimed dictator and his administration.
stoney
never knew about your son and i'm truly sad for his condition. i read somewhere that you were cherokee and so am i , i live on a reservation in montana and the tribe here covers all my medical needs in entirety and some of them are really expensive,don't know what the hell i would do if i worn't native. best of luck to you ,i know the great spirit is in your heart as it is in mine.
montana freeman
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