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Besides Prescription Drugs Editorial, The Washington Post September 15, 2003 MEMBERS OF CONGRESS are pretending that the Medicare bill, currently bogged down in conference negotiations, is simply about prescription drugs. Not quite. Both House and Senate versions of the bill contain provisions designed to help particular companies and congressional districts, benefiting everyone from Weight Watchers International to marriage therapists to doctors in Alaska. The legislation also contains measures to shore up rural health care, adjust doctors' pay and patch up bits of the Medicare system that don't work. And it has new rules allowing the re-importation of prescription drugs from Canada and elsewhere. Some of these measures are justified, some not. The most expensive provision in the House bill would create "health savings accounts" -- in effect, tax shelters. While it is a good idea, in principle, for people both to save for health care costs that health plans don't cover and to manage some of their health-care money themselves, this is an extremely expensive program. The cost to the budget is more than $170 billion over 10 years, which comes on top of the $400 billion that the bill is already going to cost -- and this at a time of soaring budget deficits. The creation of costly health savings accounts should be considered as part of a fundamental restructuring of health care, not tacked on as an afterthought. If some of the budgetary costs have attracted little attention, the costs to Medicare consumers have attracted less. There are a variety of proposed payment increases, including small co-payments for home health delivery, as well as higher outpatient charges. Because the bill offers drug discounts to lower-income seniors and requires higher payments from wealthier seniors, some in Congress (and outside) worry that all seniors will be forced to disclose their income to insurance companies, a violation of privacy. Both House and Senate bills establish a new bureaucracy, designed explicitly to administer the private providers of Medicare. In the past, the Centers for Medicare and Medicaid Services administered the entire program, but the new bills would create a parallel agency at the cost of $10 billion. There is also a provision that would, in effect, prevent doctors who dispense chemotherapy in their offices from charging extra for the drugs, a practice that has long been used to cover nursing and other costs associated with delivering chemotherapy outside of hospitals. Instead of providing a proper compensation for these services, the bill simply removes the extra charge, a change that could force many cancer patients back into hospitals. The conclusion? Far from the "major piece of reform" this bill is sometimes styled as being, this Medicare legislation contains yet another hodgepodge of half-measures that do little to cure the system's deeper ills or to cut its long-term costs. Is this really better than no bill at all?
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© 2002 Global Action on Aging |
