Bush wants to cut $70 Billion more dollars from Medicare and Medicaid issuing what amounts to a death sentence to many health care providers in conjunction with the 2005 Deficit Reduction Act and Medicare Part D (which turned over prescription drug coverage for Medicare recipients to private companies) that went into effect last year. As if the the Deficit Reduction Act of 2005 didn’t reduce Medicare ($6.4 billion) or Medicaid ($4.7 billion) funding from 2006 to 2010 enough, he’s doing it again. This time cuts with be aimed at hospitals (of which 2/3’s are already losing money treating Medicare patients), the Children’s Health Program, and pharmacies (who are already underpaid on each Medicaid transaction by an average of 36%). I read this yesterday and strongly agreed:
"As he proposes $70 billion in cuts to these programs, President Bush will say that he is trying to address long-term financial problems in these programs," Davenport said. "He is trying to treat a symptom, not the disease. The real problem is that health care costs in the United States are out of control. The president hasn't offered any meaningful solutions for controlling health care costs." [link]
And how would the president go about doing this you may ask? Simple: follow the old adage “an ounce of prevention is worth a pound of cure”. Take for instance the Asheville Project, a pharmaceutical care demonstration project conducted in North Carolina to prove that greater concentration of community pharmacists’ roles in health care can actually reduce health care costs considerably. A group called NCCPC offered to train community pharmacists in diabetes management and to offer pharmaceutical care services for city employees with diabetes. Employees who enrolled in the program agreed to go through formal diabetes education program and also agreed to meet on a regular basis, usually every month, with one of the specially trained pharmacists, who they selected from a list of those who had also gone through the training.
At the end of the project Average hemoglobin A1c results for the 40 City of Asheville employees decreased from 7.6% to 6.2%. Total cholesterol averages dropped from 210mg/dl to 198 mg/dl. The LDL average decreased from 118 mg/dl to 98 mg/dl. All of these averages exceeded the American Diabetes Association goals of <7%>.
"As he proposes $70 billion in cuts to these programs, President Bush will say that he is trying to address long-term financial problems in these programs," Davenport said. "He is trying to treat a symptom, not the disease. The real problem is that health care costs in the United States are out of control. The president hasn't offered any meaningful solutions for controlling health care costs." [link]
And how would the president go about doing this you may ask? Simple: follow the old adage “an ounce of prevention is worth a pound of cure”. Take for instance the Asheville Project, a pharmaceutical care demonstration project conducted in North Carolina to prove that greater concentration of community pharmacists’ roles in health care can actually reduce health care costs considerably. A group called NCCPC offered to train community pharmacists in diabetes management and to offer pharmaceutical care services for city employees with diabetes. Employees who enrolled in the program agreed to go through formal diabetes education program and also agreed to meet on a regular basis, usually every month, with one of the specially trained pharmacists, who they selected from a list of those who had also gone through the training.
At the end of the project Average hemoglobin A1c results for the 40 City of Asheville employees decreased from 7.6% to 6.2%. Total cholesterol averages dropped from 210mg/dl to 198 mg/dl. The LDL average decreased from 118 mg/dl to 98 mg/dl. All of these averages exceeded the American Diabetes Association goals of <7%>.
So instead of treating the “Medicare/Medicaid” problem by making tax cuts, Bush is actually cutting off help at the source.
And THAT is because he’s in bed with everyone from big pharma companies like Pfizer and Merck to pharmacy benefit managers like Caremark and Humana (who reported net income of $487.4 million, up 64 percent from $296.7 million a year ago thanks to its burgeoning Medicare Benefit Program). And speaking of record profits, who else but Exxon Mobil is raking in a fortune! The juggernaut’s earnings are up $3.4 billion from 2005!
But that’s not the only place the money is going…
“…The committee calculated that the $12 billion in cash, most of it in the stacks of $100 bills, weighed 363 tons and had to been flown in on wooden pallets aboard giant C-130 military cargo planes [to Iraq]. “Who in their right mind would send 360 tons of cash into a war zone?” Mr. Waxman said. “That’s exactly what our government did.”
This government needs some help. Seriously. Hillary? Obama? ANYONE??
21 comments:
i think the diabetes study in ashville hit another big point. education in disease patients will save a lot of money. most diabetics don't know what is really going on, they just know the horror stories of what could happen. if president bush took a tenth of the billions he cut and reinvested it into health education and disease prevention, he would easily save enough money to play in iraq with another 20,000 more troops.
this isn't a soap box. this affects everyone, even those who aren't on medicare and medicaid. if you want a soapbox, rant about swords, salad, spiderman and other fun "s" words.
I love that not very long ago, like maybe just one year ago, you had a big, fat, "W" sticker planted directly on your vehicle.
Andrew – Thanks for the encouragement. I have been really upset about this for a while and I just finally had to write it all down.
And I agree with you 100%. Disease State Management could save the government way more than they realize. In a summary I read on the Asheville Project, it said for every dollar spent on prescription drugs and diet, exercise and lifestyle counseling, the city of Asheville saves $4 on things like trips to the emergency room, dialysis, amputations and various other diabetes-related complications. But, and you know this, it doesn’t stop with diabetes. People living with chronic conditions like hypertension, high cholesterol, and asthma also cost the government an insane amount of money. And it’s mostly because they are uneducated about their health risks whether it’s genetic or lifestyle driven, and their different treatment options. If the government was to develop or fund a health care management program where patients, physicians and pharmacists work hand in hand to educate themselves/their patients about their conditions and how they can prevent/stabilize them, it would provide phenomenal relief to the health care crisis. Unfortunately, with things the way they are, everyone in health care is taking such a big hit that no one really has the opportunity to move toward programs like this. They’re too busy trying to stay afloat.
Brian – What you say is true, and I am ashamed. I will most likely never vote Republican again.
Liz, clearly there is plenty wrong with health care, but what do Humana (a peon) and Exxon have to do with any of this? Exxon makes about 100b a quarter, so they probably expect at least a 3% growth in income. Are they supposed to be forced to give money to the government beyond what they are regularly taxed? Secondly, wouldn't you rather Medicare be administered privately? Don't you agree that companies like Humana are a lot more efficient at expense control than the government? They are making big money now because they are assuming massive political and antiselection risk. (Also, my intuition is that Humana is gonna get bombed by claims emergence in the next several years.)
You are right on about prevention. That is how you make money in Managed Care insurance. But, that requires a degree of personal responsibility... and Americans aren't so great with personal responsibility (see exercise, nutrition etc).
Why don't you run for president, since you've got it all figured out?
anon - why don't you eat a crap sandwhich since clearly that's fitting sustenance for what comes out of your brain.
crap head.
Part D Plans like Humana have EVERYTHING to do with what I’m saying.
When the federal government “turned over” prescription drug coverage to private companies (like Humana) last year, they set up agreements with them that would ensure a minimum amount to be reimbursed per beneficiary upfront. The private companies would in turn determine the reimbursement rates at which pharmacies would be paid per Medicare transaction. These companies favor big pharma companies because the drug companies give them rebates with every sale of a brand name drug (which is more money in their pocket that should be going to pharmacists), so instead of pushing generic drugs which would lower the cost of health care, they offered higher reimbursement ratios on brand name drugs and below cost reimbursements on generics. Most Medicare beneficiaries are living on Social Security or Disabiltity and cannot afford brand name drugs, so they opt for cheaper generic versions which cause pharmacies to lose money on every transaction.
I can’t tell you how many pharmacies that are part of my coop have closed their doors after decades because of Medicare Part D’s influence. It is absolutely staggering.
So to answer your question: YES! I would love for prescription drug coverage to be administered privately, but it’s not- the government is still very much a part of it. And these private companies are making big money now because they’re screwing everyone. They’re getting paid up front by the government, getting rebates from the drug companies, and they’re squeezing the life out pharmacies. And what’s crazy is that no one gets it!!
And the thing about prevention is that health care management has to start with open lines of communication between all aspects of the health care system from physicians, pharmacists, AND PBM’s before you can even get to patient responsibility. But like I said, no one is willing to open up to it because everyone is so concerned with making sure they get paid. If technology, like say e-prescribing, were more patient-centric than payment centric, the presence of such health care programs would be much more of a possibility via the sharing of medical history and the success or failure of previous drug treatments. Sure Americans aren’t good about taking personal responsibility for their health, but why should they? There’s not really anything to help them even if they were. Sure there are weight loss companies out there, but generally people to go them for limited periods of time, whereas people typically find a physician and a pharmacist and stick with them for life. Plus those companies can’t offer blood test analysis or prescription drug therapy. I really believe that opening these lines of communication, along with professional transparency of all companies involved is essential to helping Americans get on track to personal responsibility which is an integral part of lowering health care costs.
And I mentioned Exxon because it’s just another example of how our government loves to make friends with companies with money. It really has nothing to do with the health care crisis; I was just on a bitching roll.
And anonymous- I don’t claim to have all the answers, I’m just really saddened that on a regular basis I am getting calls from my members telling me that they’re going to have to close their pharmacies that have been in their families for generations. I think finding a solution begins with dialogue, which is what I’m trying to propagate here. If you don’t have anything beneficial to add, I suggest you don’t make any more comments. Thanks.
I don't know much about pharmacies. Forgive me, Liz, but I find your knowledge and interest level in pharmacies bizarre and fascinating. I take it you work in a pharmacy or for a pharmaceutical trade group?
For what little it's worth, I've had the impression for about ten years that the pharmacy industry is in a rapid wave of consolidation, moving from independently owned and operated pharmacies to the big CVSes of the world, and that this wave of consolidation is what's wiping out independent pharmacists. I'm open to being convinced that Medicare is really hurting them, too, but I also had this reaction to your post:
1. Americans demanded that Medicare cover prescription drugs.
2. The Republicans said it would be a bad idea because the government isn't really very good at doing health care, and lots of inefficiencies and bad things would happen, and there would be lots of unforseen bad consequences.
3. The people said, "We don't care; we don't believe you; you just don't care about old/sick/poor people!"
4. The Republicans caved in and gave the people what they wanted --a Medicare prescription drug plan.
5. Immediately, the people reacted by complaining about the program's inefficiency, poor design, and (now) unforseen complications and negative impacts.
When the government gets involved, there will be winners and losers. You're making a very good case that the pharmacists (particularly the independent ones, I'm guessing) are the losers, and that the big drug companies are the winners. I am sorry for the pharmacists.
john- I actually work for a pharmacy cooperative (essentially a buying group for independent pharmacies). we help negotiate better prices for drugs, amongst other things.
to your first point about there being a explosion of retail chain pharmacies like CVS and Rite Aid. This is not due to an industry-wide movement towards consolidation, it can mostly be attributed to independent pharmacies not being able to survive the recent pounding waves of legislation that have forced them to sell to chains. The reason the chains have been able to thrive is because they do so much front end retail. Filling prescriptions is just a small percentage of their overall profit.
And yes, you’re right. Americans did demand that a prescription plan be implemented for those eligible for Medicare. And for the most part, it has been hugely successful. The average premium paid by Medicare Part D recipients in 2006 was $32.20. That is fantastic. The problems that everyone is complaining about? The implementation of the program was horrific. Dual-eligibles (those eligible for both medicare and Medicaid) were automatically enrolled in a plan by the government. For many people this was a huge problem because the plan they were automatically enrolled in did not provide coverage for certain prescriptions that they needed. Others ended up enrolled in two different programs accidentally. Then there was the issue of not having open enrollment. The deadline for enrolling in 2006 was May 15th, and there was an automatic penalty if you didn’t make the cut off but many of the elderly were so confused by the process that they missed it. Not to mention that 100% of costs in the medicare part D "doughnut hole" (a lapse in coverage between $2250 and $5100) equaling a total of $3,600 has to be paid out-of-pocket. Why would they do this? The thing is: I have no idea. I mean, it’s not like they need to make up for losses…they’re making their money upfront through the government. But that, along with all the other things I mentioned were definite and understandable reasons to be dissatisfied with the program.
There’s a saying that my grandfather used to say, and my dad now says about the government that I think is very fitting: If the federal government were in charge of making beer, it would cost $30 a pack and it wouldn’t taste very good.
Cheers to local government.
Once I finish enjoying my 'crap sandwich' that your husband so lovingly suggested, I might have something useful to add. (Isn't he in ministry?)
There. Mmmmmmmmm.
Let's see. My suggestion would be the same one that is somewhat implicit in your original post (though I am going to greatly oversimplify). Less government, not more. Eliminate the third party payment system.
When drug companies have to sell their products directly to consumers (instead of to insurance plans and the government), then they will finally have an incentive to develop products that people can afford. Though, no doubt there would be a difficult transition period. Maybe the local church could step in and actually help some people at that time. Big government and HillaryCare certainly aren't going to save us.
For another similar example of why "less is more," go to www.nationalreview.com and read Larry Kudlow's article "When You Tax Profits, You Tax People." He knows a lot more about this sort of thing than I do (it's the crap sandwiches. . .).
Anonymous- Clint was just standing up for me, like any husband would do. And no, he’s not in ministry. He’s a musician.
You are right about one thing: the problem with the US is that the government has already become too large. There’s no telling how many employees they have or what the hell they all do exactly. Here’s where you have me wrong: I’m not a democrat. I am actually more closely aligned to the libertarian party than any other party. I think big federal government is bad and that a smaller, more local government would be more effective and is what our forefathers had in mind. I said Hillary and Obama because a) they are both Senators and have the power to push legislation that would help this situation b) realistically speaking, a libertarian candidate is not going to be elected, and lastly because I have grown weary of the Republican party’s close ties to big business and their abundant ethics violations. I’m tired of the Jack Abramoff’s, the Bob Ney’s, the Tom Delay’s and all of the other greedy Republican bastards that have dirtied up the system with their corruption. Or who could forget Mark Foley’s inappropriate behavior with young male congressional pages?? This man is in direct violation of, and will be prosecuted with legislation he helped pass!
This administration has thoroughly embarrassed itself and Washington is stale with leaders that have only kept their seats because of money and zoning. It’s time for a change and I’m impartial to whatever party pioneers them, as long as they happen.
hey anon.
come after me and clint all you want, but leave liz alone.
and it's not that she needs me to stick up for her, it's just that your presence here is so rude and unwelcome.
please come over to my blog and be an ass. you'll fit right in.
Liz,
Great thoughts, and I apologize for baiting you with the "if you're so smart. . ." comment. Kudos to you for answering evil with good. Ought to do more of that myself. It was a delicious crap sandwich, however.
For the record, I never said you were a Democrat. You actually come off pretty Libertarian at the get go. You're also right about corrupt Republicans. But realize just for a second that the leading Democrats have no plans whatsoever other than seeing themselves in power. Don't believe for a second that Hillary cares about anyone other than Hillary. Health care is merely a stepping stool to her, a tool to be used to get her the control and power that she thinks should be hers. Just look at how she spends her own money (million dollar home, anyone?).
Obviously, we won't exhaust the discussion here, but I think that you would be decidedly dissatisfied with any changes that Hillary (or Obama) would bring.
So, seriously, why don't you run for office (maybe not president)? I can tell that you at least care about someone besides yourself.
Brian,
Is this a private conversation? I'm not e-mailing this stuff after all. If I have offended in any way, then I sincerely apologize (and I do apologize).
But, if you post in a public place, and you have a blog that allows for comments, you might get some comments every once in a while. You might get comments you don't like even. That's what happens when you share your diary with the world.
However, since you feel that I am "rude" and "unwelcome," then adieu. I will not trouble you further.
Anon - Glad you liked your crap sandwhich.
i really want to jump into this hoopla and have a big turd-dumpster sandwich with the other guy, but i have a (guess what) pharmacology test monday with a couple hundred antibiotics, antiparasitics, antifungals, and antineoplastics. go figure.
but i've enjoyed reading this. fortunately, the drugs that prevent diseases cause pennies, and they are exercise, a good diet, and a moderate lifestyle. i wish they would test me on those monday. i'll chat/complain/bitch with you in a few weeks, ma'am. are you going to be at patty griffin? i will, with kelly, sort of obviously. i win.
liz,
you know a lot about this. i think it's pretty cool that you take so much joy and interest in what you do.
i mostly agree with what you have said particularly in the area of education and prevention. what house had to say about prevention being made up of excercise and diet is unfortunately what many in power (corporate and political) don't want to hear. the solution to rising health care costs is not finding ways to pay for drugs, or at least not entirely. unfortunately we have a drastic shift in population toward seniors that will require more medication which will cost more money. as our country gets increasingly larger through birth and immigration these costs will get even more out of control. as with most things your best answer is usually the simplest (education and prevention). if i were president i would hush the big players in this which are the pharma companies, insurance providers, and possibly even pharmacists (to a certain extent) because they are profit motivated. i agree that we need to assist local pharmacists as well as other local businesses, but their solution is going to be only part of the story. what the government should do is look at what has been successful in other areas of gridlock, public-private partnerships. and i don't mean the type of partnership which just helps people make money unfairly as you have suggested with companies such as Pfizer and Merck. Governments should use the resources of quality educational institutions (such as UAB), existing beuaracracy such as medicare and medicaid, pharmacists, pharm companies, and the not-for-profit sector (such as United Way and community foundations) and develop a broad based education, prevention, and treatment plan that focuses on demographic segments to triage the health-educational blight that we see today. the fact is that the government is the expert right now. they have been doing this for a long long time and should not be disregarded. but the efficiency issue cannot be ignored and that's why you must bring in players that have to efficient (corporate and non-profit). this would likely look like a grant based program that is administered through Medicare and Medicaid that are given to non-profits to implement specific plans of action that are results based. it would be in the best interest of the non-profit to work with educational institutions and pharmacists and pharm companies because the product knowledge is there. it would be in the best interest of the companies because they can make a difference and it's great PR. i think this could keep government from growing too much and hopefully result in a better educated population and thus lower health care costs.
there is my box of soap.
i love reading your stuff by the way.
josh w.
shit!
my comment was so long.
i must like to hear myself talk...er...type.
i apologize.
the ass formerly known as josh w.
i'm sitting at a coffeeshop studying and there is a girl who looks exactly like you (with about 95% certainty) who is talking with a guy (who is obviously infatuated with her and would agree with anything she said), and she is explaining how all christian music should be free, and people should go door to door giving it away. i wanted to punch her. then she talked about her favorite praise albums for 30 minutes that she downloaded of kazaa because it should be free anyway.
btm- thanks. good to have friends like you.
josh- um, did you see all of my comments?? they were novel length. plus i like to reading your thoughts, you write good things so no worries.
andrew- that does not sound like a fun test to take. good luck. and wow, that girl sounds really obnoxious. you totally should have punched her. right in the baby maker.
You voted Republican?! Terrible. Obama and Clinton are going to be in Selma on Sunday for the Jubilee kick off thing. Also did you see on MSN today a kid in DC died from a tooth infection becaust their medicaid got cut and the abcess leaked bacteria into his brain. crazy shit!
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