Lo's Sharebook 

    'D' For Disaster
    By Robert Hayes
    TomPaine.com

    Friday 07 April 2006

    Picture this movie: It's 2003 in the wealthiest nation in the world and millions of Americans are suffering needlessly and dying prematurely because they cannot afford medicine.

    Employers have hiked up the cost of their retiree drug coverage and pharmaceutical companies have continued to drive up the prices of life-saving prescription drugs.

    Congress and the president know they must act or risk being run out of office. There is near-universal support to add prescription drug coverage to the nation's treasured Medicare program.

    So, two of the nation's most powerful economic interests, the drug and insurance industries, are invited up to Capitol Hill to collude with leaders of Congress to develop a prescription drug benefit - one that serves their interests.

    Taxpayers, senior citizens, people with disabilities: be damned. We have friends to pay back.

    Working with $700 billion in taxpayer funds, the congressional leadership - all Republicans except then-Louisiana Sen. John Breaux (now a covert, but highly-paid lawyer for the drug lobby) and Montana Sen. Max Baucus - hides behind closed doors and gets to work.

    With no public oversight and with the press milling outside locked doors, the congressional junta drafts legislation locked arm in arm with the puppeteers that control the federal government.

    In a back room, they design a drug "benefit" that allows the pharmaceutical companies to further inflate the price of medications and reap billions of dollars in windfall profits. They promise tens of billions more in profits to health insurers to deliver this coverage.

    But there is a human cost - this $700 billion package is leaving millions of older and disabled Americans worse off and millions more of them still without drug coverage.

    The administration spin machine is hard at work to pretend that this tawdry story is not the reality facing the American people today.

    Health and Human Services Secretary Michael Leavitt, with all the credibility of President Bush's now 3-year-old "Mission Accomplished" speech on the deck of the USS Abraham Lincoln, is going around the country zanily proclaiming what a marvel this drug program is. This week Leavitt unleashed a new, glossy "Progress Report " on the drug benefit. Page one proclaims, falsely, that "[m]ore than 27 million beneficiaries now enjoy Medicare Rx drug coverage."

    Here's the reality: 16 million Americans with Medicare-men and women age 65 and older and people with severe, long-term disabilities-still have no drug coverage. Just 7 million Americans who were uninsured before the drug program was launched are newly insured. Six million of the poorest and frailest Americans who lost Medicaid coverage on January 1 now have inferior, less-reliable drug coverage. And the anger and dissatisfaction of people who are enrolled in drug plans increases each day as they discover how inadequate and unreliable the benefit is.

    Coverage gaps, excessive out-of-pocket costs and routine denials of coverage for needed drugs are commonplace. Even enrollment in a private drug plan frequently leaves older Americans going without the medicines they need.

    In this springtime of national discontent, the nation's prescription drug program resembles the rebuilding of New Orleans and the war in Iraq. They each serve as a human tragedy, an administrative fiasco and a predictable consequence of politicians willing to squander the national treasury so long as it goes into the pockets of their mercenary supporters.

    For the past 40 years Medicare has been a national treasure. It has done what it promised when signed into law by President Lyndon B. Johnson in the summer of 1965. Medicare, a humane, reliable and efficient (yes, a government-run single payer) health care system, allows Americans to live longer, more productive and better lives.

    Had the drug benefit been administered directly by Medicare, doctors, rather than profiteering insurers, would decide what drugs are needed, and Medicare would use its substantial purchasing power to bring U.S. drug prices in line with the rest of the world. (Americans, on average, pay double the price of other developed countries for the same medicine.)

    Instead, where are we left? With a drug program that is enriching insurance and drug companies, helping far too few Americans in need, and an administration in a full-court propaganda campaign to convince the electorate that all will work out in the end.

    So Secretary Leavitt, on behalf of his president, continues his whistle-stop tours. But he does it in the face of his own parents, enrolled with Mr. Leavitt's help in the drug program, having to rush to drop their plan because it imperiled their retiree medical coverage. Yes, Dad, perhaps we could have done better.

    Did you know that Secretary Leavitt's father, now 76, made his fortune in the insurance business?

    This could only happen in a movie.

    We wish.

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    Robert M. Hayes, an attorney, is president of the Medicare Rights Center, the nation's largest independent source of information and assistance on health care rights and benefits for older and disabled men and women. He led the national and New York Coalitions for the Homeless from 1979 to 1989, and has practiced law with firms in New York and Maine.

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    Massachusetts Sets Health Plan for Nearly All
    By Pam Belluck
    The New York Times

    Wednesday 05 April 2006

    Boston - Massachusetts is poised to become the first state to provide nearly universal health care coverage with a bill passed overwhelmingly by the legislature Tuesday that Gov. Mitt Romney says he will sign.

    The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines several methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government.

    "This is probably about as close as you can get to universal," said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. "It's definitely going to be inspiring to other states about how there was this compromise. They found a way to get to a major expansion of coverage that people could agree on. For a conservative Republican, this is individual responsibility. For a Democrat, this is government helping those that need help."

    The bill, after the product of months of wrangling between legislators and the governor, requires all Massachusetts residents to obtain health coverage by July 1, 2007.

    Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government subsidies to private insurance plans will allow more of the working poor to buy insurance and will expand the number of children who are eligible for free coverage. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year.

    All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected.

    "It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan," said Stuart H. Altman, a professor of health policy at Brandeis University. "It isn't that at all. It is a pretty moderate approach, and that's what's impressive about it. It tried to borrow and blend a lot of different pieces."

    Many states, including Massachusetts, have been wrestling for years with how to cover the uninsured, and several states have come close, according to the National Conference of State Legislatures. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but nearly 10 percent of people remain uncovered. Efforts to cover all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat in the mid-1990s when the language in the bills concerning universal coverage was repealed.

    In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004. Massachusetts would be the first state to require its citizens to have health insurance.

    The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26.

    Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system.

    The Massachusetts bill was hammered out with proposals and input from state Democratic legislators; Mr. Romney, a Republican; Senator Edward M. Kennedy, a Democrat; insurers; academics; businesses; hospitals; and advocates for the poor, including religious leaders.

    They were motivated in part by a threat by the federal government to eliminate $385 million in federal Medicaid money unless the state reduced the number of uninsured people. The state was supposed to have the bill completed by January, but state officials said they were confident that the federal government would approve of Tuesday's bill.

    "Whenever you can have the medical community, the business community and the advocates all applauding our efforts, I think that's indicative of a successful exercise," said State Senator Robert E. Travaglini, the majority leader.

    Mr. Romney, who is considering running for president in 2008, said in an interview Tuesday that the bill, passed by a legislature that is 85 percent Democratic, was "95 percent of what I proposed."

    He said, "This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone."

    Mr. Romney pushed the idea of the "individual mandate," requiring people who can afford insurance to buy it. The bill makes it possible for employers to enable many of those people to use pretax dollars, saving them 25 percent or more. Individuals who fail to get health insurance by July 2007 will first lose their personal exemption on their state taxes. In subsequent years, they would have to pay a penalty that could be as high as half of what an affordable health care premium would cost.

    Eric Fehrnstrom, the governor's communications director, said that for those people with incomes above 300 percent of poverty, "our assumption was that these would be mostly single mothers who just did not have the wherewithal to get insurance. It turned out it was mostly young males. In some cases they are making very attractive salaries. These are people who just don't imagine themselves needing care, but of course when they break a leg when they're out bungee jumping they go to the hospital and we end up paying for their care anyway."

    One element that Mr. Romney and some legislators did not want was the fee for employers who do not provide health insurance.

    For several months the bill seemed stalled because the House and Senate leaders could not agree on the issue of charging businesses. One proposal of an $800-per-employee charge was reduced to a maximum of $295 that would go toward paying costs for the uninsured and would be reduced as more people became insured, Mr. Travaglini said.

    Because the bill is part of a budget bill, Mr. Romney has line-item veto power. He said Tuesday that he would likely change the business fee provision in some way or veto it before signing the bill.

    Still, he did not seem that worried about it, saying he had been most concerned that the fee not be a payroll tax, as had been originally proposed. Mr. Travaglini said that if Mr. Romney vetoed the business fee, the legislature would override it.

    Bob Baker, president of the Smaller Business Association of New England, said his members seemed to accept the idea of the fee.

    "The notion of the level playing field, I think from an element of fairness and equity, people are O.K. with it, unless it impinges on their ability to pay for it," Mr. Baker said. "There hasn't been a hue and cry among our members."

    Mr. Romney said that with more people insured, everyone would "get better health care" and that premiums for people who already had insurance might drop because "providers won't be pushing the cost of the uninsured onto the people who have insurance."

    James Roosevelt Jr., president a?d chief executive of Tufts Health Plan, agreed.

    "I think that will help both improve the quality of health care and lower the cost," Mr. Roosevelt said, but he added, "We would have liked more flexibility in the design of health plans to permit lower premiums that are affordable for all people."

    The program, which was approved 154 to 2 in the House and 37 to 0 in the Senate, will cost $1.2 billion over three years, but only $125 million of that will be new state money. The rest will come from federal money and existing state money. After three years, lawmakers say, no new state money will be required. A new agency will administer the system.

    Advocates for the uninsured held a victory rally at the Statehouse.

    "We're thrilled that this truly represents a commitment to the poor and the working poor," said Rabbi Jonah Pesner, a leader of the Greater Boston Interfaith Organization.

    Joseph Landais, 64, could use insurance for himself, his wife and three children. Mr. Landais, a retired hospital custodian, said his wife, a nurse's aide, makes too much for the family to be eligible for Medicaid but not enough to afford insurance. He had a hernia operation four months ago that he did not have to pay for under the free-care pool, but he had not been able to see a doctor since then, even though he is still not feeling well.

    "After years that you've been working that hard," Mr. Landais said, "I think you deserve something back."

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