A quick refresher on this multibillion-dollar turkey is in order. Its provisions haven't kicked in yet, but it is already the law of the land, and we'll soon be rapidly heading down the tubes with it when it actually starts sucking up money (madly) in January.
Medicare is the federal program that provides hospital and medical care for persons over 65 and for a few disabled persons under 65. It is characterized by widespread acceptance, miniscule administrative costs … and several glaring omissions in services that it will pay for. Chief among those was that it will pay for doctors and hospitals, but not for medicine. That is left up to individual patients.
For those who can't afford the costs of prescriptions, the usual policy is to establish them as eligible for Medicaid, the program operated by individual states for low-income people and children.
People who get care from both Medicare and Medicaid are referred to as “dual eligibles.” The federal government shoulders the cost of these people's healthcare, except for drugs and nursing homes. Those are the responsibility of Medicaid, with the states picking up a chunk of the tab. That “chunk,” over time, has become incredibly draining for state governments.
Originally, the idea behind the prescription drug enhancement to the Medicare program was to try to relieve some of that burden on the states while making the soaring costs of life-saving medicines affordable for all elderly.
Then the lobbyists for the drug companies got involved. They were the true drafters of the 800 pages of dense prose which ultimately made up the measure that Congress passed, apparently without bothering to read.
When it was being debated last year in Congress, I wrote in this column that “at least one good result would be that the 50 states' Medicaid programs will no longer have to pay the full bill for elderly people's medicine costs.” Boy, was I wrong.
Turns out there is a nifty little something called a “claw back” provision built into the measure's small print. (Who dreams this stuff up, anyhow? Out-of-work advertising executives? Former comic book writers? I mean, “claw back!” Priceless.)
This week the federal government began revealing to state Medicaid program administrators just how deep a scratch that “claw back” will make in state budgets. And the painful screeches coming from Human Services Department Secretary Pamela Hyde's office in Santa Fe are being lost in the chorus of anguish emanating from all 50 states.
In New Mexico's case, the Bush people have notified us that instead of providing fiscal relief for taking over drug purchases of dual eligibles, they are expecting New Mexico to fork over a sizeable additional amount to compensate Medicare. And if we, as Texas, New Hampshire and a few other governments are muttering mutinously about doing, refuse to pay the extra tab, they'll simply withhold enough of our other federal funding to cover the cost.
This is a king-size “gotcha!” that deserves to be publicized and protested widely. Congress has already begun working on the gory task of dismembering practically every single program for the poor in the federal inventory in order to pay for the murderous costs of both of President Bush's disasters–the war on Iraq and additional tax cuts for the wealthiest 10 percent of Americans. It will not be eager to hear from states that the $75 billion-a-year prescription drug benefit should be made a lot more expensive by not squeezing the states for a piece of its cost.
Tally up the problems with the Medicare prescription folly and you can't avoid concluding that it is an enormous disaster that will break the bank (I know, I know, the federal bank has long since been broken, looted and abandoned by the Bushmen; but still …) and that will provide scant improvement in our scandalous healthcare non-system.
The pharmaceutical lobbyists made sure we can't negotiate lower prices for medicines, can't import them from Canada or Mexico (where they are less costly), can't simply let doctors pick the appropriate drug to be used and can't permit patients to deal directly with pharmacists—instead, they have to enroll in some Rube Goldbergian HMO to be able to use this benefit.
They also have to pay premiums, co-pays and deductibles. And still the astronomical cost of this new law (estimated to be $400 billion over 10 years when it was voted on, only to be suddenly bumped up to $740 billion one week later) rivals the Iraq War as a drain on the public coffers.
The only beneficiaries are the drug companies and the HMOs, both of whom will skim big bucks from the trough. The losers are all the rest of us … now including the state Medicaid programs. How could anything worse have ever been dreamt up?
Rep. Heather Wilson has announced she will oppose the Bush Administration's proposed cuts in programs for the poor. If she would derail the claw back provision of the Medicare drug bill, she would earn our eternal gratitude. That would be a real accomplishment.
The opinions expressed are solely those of the writer. E-mail jerry@alibi.com.
