|Quoting DXing (Reply 58):|
Part D was enacted to lower prescription drug prices
Part D was enacted to lower Rx prices for the patient only. The patient pays a variable co-pay, but the actual cost of the drug is not lowered significantly. The plan pays the rest of the expense. When or if someone reaches the donut hole, it is based on the true prices of the meds the pt has bought, not on their co-pays. The only reason relatively few patients reach the donut hole is because most of them are taking mostly generic drugs. Guess what? They were already taking mostly generic drugs before part D was enacted because they couldn't afford brand name meds anyway. Part D has still been tremendously expensive to taxpayers, regardless of how you look at the statistics. Comparing part D's "stunning success" with parts A and B is like comparing apples and oranges, to a large extent, because part D covers a single item.
Your argument that the huge number of part D plans is keeping prices down is flawed, as well. Each state has a much smaller pool of plans from which to choose, yet the nearly universal agreement among both government and health care professionals is that there are far too many plans, which has actually led to an unwieldy system in which most patients find it extremely difficult to determine which plan is best for them. In fact, the total number of part D plans has been decreased, but not enough. The large number of plans has also created an absolute nightmare for health care providers, who cannot possibly know the regularly changing covered meds for each program in their state. This has created a horrible burden of extra labor and wasted time for providers who serve Medicare patients. In the beginning, one could access any part D plan via Epocrates.com, so things were a little easier. Now, there is no unified, user-friendly, easily accessible site to access all the plans because many of them tried to make Epocrates pay to publish their formularies, which Epocrates refused. It becomes a time-wasting guessing game because the part D plans usually just reject a Rx for an uncovered drug, without the courtesy of informing the pharmacy or provider what similar drug is covered. I favor part D, because it does provide greater access to medications (those that DON'T have generic equivalents), but its current version is not the Utopia you have claimed.
By the way, Medicare sets the national standard by which other insurers are measured. Private health plans would provide much less coverage and get away with much more in terms of the dreaded "preexisting conditions" as an excuse for denial of coverage without something else to set the benchmarks.
Perhaps the most basic point you miss in all of this is that Medicare and Medicaid cover the sickest populations in society: the old, the disabled, and the socioeconomically disadvantaged, who have many more health problems per person than the private insurer population. There is no fair way to condemn the federal programs compared with private insurers, because the federal programs cover MUCH sicker patients. Did you know that any patient who has to go on chronic dialysis automatically qualifies for Medicare, regardless of age? That is a HUGE cost to the program--one that most private insurers barely deal with by comparison.
By the way, Medicare part B is not mandatory for all Medicare patients. Many have part A only.
Why do an increasing number of MD
's not accept Medicare patients? It's not as simple as you think. The increasing number of patients in Medicare part B HMO
's with capped payments is one contributor. The much higher level of illness of Medicare patients is a major contributor. In the standard 15 minute follow-up visit, it is nearly impossible to address all the needs of a Medicare patient with a half dozen or more chronic problems plus one or more acute complaints. The incremental pay increase based on complexity of visit is not enough to make up for what an MD
can make by seeing more comparatively healthy, insured patients during those 15 minute slots.
Nobody in Washington has put a serious proposal for Medicare A and B reform out there in recent years. The only "reform" that has gotten anywhere has been annual budgets proposing cuts in reimbursement. In its rare displays of bipartisanship, Congress has wisely rejected these cuts every year.
Private insurers have a lot wrong with them, too. There's a big reason that a crisis is looming in primary care medicine. Compensation is inadequate universally for the complex level of comprehensive care primary care MD
's are expected to provide. The private insurers don't reimburse primary care MD
's all that well, either. That's why so few graduating medical students choose primary care now. They see during their clinical rotations how much garbage a primary care provider puts up with for a comparatively much smaller paycheck. When the primary care MD
's of my generation start retiring in large numbers, which will be fairly soon, access to a primary care MD
will be MUCH more difficult in the US.
Despite the AMA
's recently expressed reservations about the universal coverage proposals, most surveys of physicians have shown a great majority favoring some form of universal coverage for at least twenty years. A lot of us who have seen the crisis of the uninsured extensively know that universal coverage is going to have to come at some point. Most of us know, as well, that without a strong input from the federal government to force the necessary changes, universal coverage will never occur. The insurance companies and lobby are far too powerful and completely profit-driven, and they will never cooperate with reform without a strong edict from Washington. You may not like it, but it's the simple truth.