Welcome to 55 and Better

The "55 and Better" series focuses on the issues that effect everyone sooner or later. With that in mind, it is important that we join together in tackling the problems and looking for the solutions as we plan for the future. All of us have inherited a system including Medicare and Social Security from those who have fought the "good fight," now it remains up to us to continue the promise so that the years after 55 will be even better.

BIG PHARMA SCAM: Medicare Prescription Part D

(Survival inside a doughnut-hole )

It's rather difficult to discuss Medicare Prescription Part D since seemingly there are no government or agency officials willing or able to provide a clear explanation as to exactly how the scam is supposed to benefit seniors.

"Cutting drug costs for seniors" is not an explanation is it? It’s a campaign slogan.

How does it work? Is there an official explanation? Why not?

This fact in and of itself qualifies Medicare Part D as a 'scam' in our estimation.

So "scam" it will be for purposes of discussion here. We don't happen to have much tolerance for this 'entitlement' - not lacking a clear explanation for supporting the billions now added to the deficit to pay for it. A deficit for which our grandsons and daughters, and their progeny will pay and pay and pay unto the next millennium. We've been scammed again by this administration, cross-generationally we have, and we don't feel up to being particularly polite about it.

This administration has brought a whole new meaning to the word 'entitlement'. "This is our 'due'...", to coin a phrase from Dick Cheney.

How did BIG PHARMA get past congress?

Was the outrageous BIG PHARMA bill actually passed on the floor of the House? Not as per House 'rules'. Not as we witnessed it, (and we did, thanks to C-Span.) BIG PHARMA was actually defeated on the first vote in the wee small hours, and it would have stayed defeated if not for the work Tom Delay. Delay and his extortionist-henchmen set to work turning that 20 minute 'nay' vote around. It took them three hours in which they resorted to full-blown blackmail! So much for the Ethics Committee, the Rules Committee and/or any semblance of congressional oversight...( or even simple common decency for that matter.) It's simply ludicrous to trust that they "police" themselves in the Peoples' House...but that's a whole different story...for another day...or another series.

Beware the "donut-hole"

Let's talk about the doughnut-hole for a minute. Murky, it is. It's our understanding that the donut hole clause was fabricated after the bill was "passed". The reason being that the cost for the original legislation was misrepresented to Congress by Bush's Medicare lap-dog, McClellan, to the tune of a couple of billion dollars. The donut hole 'deductible', into which any one of us could fall, makes up the price differential between the actual cost for the scam and the cost upon which the scam was "passed". That is to say: after the fact. Was it deliberate you might ask? I'm sure of it, aren't you? So much for knocking the props out from under old-folks-on-walkers, the so-called "beneficiaries" of this pricey 'entitlement' program. According to The Washington Post, this is how it works:

Under a standard plan this first year, Medicare handles 75 percent of drug costs after a deductible until the bill reaches $2,250. It does not kick in again until those costs total $5,100. After that, prescriptions are almost completely paid for. The very poor can get special subsidies.

Oh well, the very poor will get some help. It is only when you see how many will fall through that hole, that the whole story gets told. Citing the same Washington Post article:

Before the program's start, the Congressional Budget Office and the Kaiser Family Foundation both projected that about 7 million recipients would be affected this year.

Then last month, a report for the national Health Leadership Council, a coalition of health care executives, pegged the number at 3.4 million. This month the Campaign for America's Future report put the estimate back at 7 million.

Seven million people, many living on fixed incomes, and all of them needing that medication to stay alive in the wealthiest nation on earth, down the hole. What's with that? Here are a few of their stories:

Retired teacher Elise Cain walked into her Silver Spring pharmacy last week for a pill she takes for diabetes, one of her dozen daily medicines. The 77-year-old woman had paid $20 in June. Her charge now is $175.24.

"I nearly passed out," Cain said.

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Columbia resident Mary Ann Anderson, 81, was caught by surprise even though she had carefully reviewed the plans. She knew she had to choose wisely given the long list of medications she is taking after having double bypass surgery in December.

"It was a huge success," she said of the operation. "But not having the drugs could kill me."

This month, Anderson went to the store to pick up three refills. With her coverage, the bill had been about $125 a month. Suddenly, it had more than doubled.

"You hit the limit," the pharmacist told her.

"What do you mean?" she asked, bewildered.

She quickly learned. She also learned that the $14,952 she nets from Social Security annually made her ineligible for many assistance programs, including those offered by pharmaceutical companies.

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WASHINGTON - Mildred Lindley is stuck in a hole, the doughnut hole — "right in the middle of it," she says — that comes with Medicare's new prescription drug benefit.

Just four months into the program, Lindley has hit the point in her coverage where she has to pick up, at least for a few months, the full cost of the medication she takes to keep her bone marrow cancer in remission. As a result, her two-month supply of Thalomid shot up from $40 to a whopping $1,300.

"If I can't get it, I guess I'm here until the Lord takes me out. That's all I can do, because there's no way I can afford it," said Lindley, an 80-year-old from Jonesboro, Ark.
"I'm in the hole all right."

The Republicans now have a looming election-year "doughnut hole" problem. On September 22, people who have been enrolled in the program since January are projected to reach the brink. What will happen then?

If Plan D is bad for the recipients, a drain on America's budget, and not even a successful Republican election gimmick, who wins?

The Success of Big Pharma

According to the Alliance for Retired Americans


The Justice Department is accusing Abbott Laboratories of vast price inflation as part of a fraudulent billing scheme that cost Medicare and Medicaid more than $175 million from 1991 to 2001. Abbott jacked up the price of the intravenous antibiotic vancomycin as much as 18 times what it charged health care providers, knowing that the Medicare and Medicaid programs would reimburse the providers based on the manufacturer's price, according to a whistleblower lawsuit unsealed Thursday and reported by the Associated Press. Abbott, based in Chicago, participated in the scheme because hospitals, pharmacies and other providers could pocket the difference and would be more likely to prescribe the company's products in the future, the Justice Department stated. Other Abbott solutions used in administering IV drugs and to replace fluids in the body also were alleged to be part of the arrangement. "If Medicare had been able to negotiate prices with Abbott Laboratories directly, the government would have saved $175 million on the fraud alone," said Ruben Burks, Secretary-Treasurer of the Alliance.

Help just might be on the way

Democrats on Capitol Hill have called for change. One proposal would have Medicare, not the drug plans, negotiate directly with the pharmaceutical companies; supporters say the savings could help eliminate the gap. Another measure, introduced by Sen. Barbara A. Mikulski (D-Md.) and three colleagues, would waive the premium for any month when a senior lacks coverage.

More Help

Hopefully a Democratic '06 congress will be able to change Plan D to eliminate the gaping hole in coverage, but until then, there are somethings we can do. It goes without saying that we write those letters, and make the calls. We're all getting smarter about that. However, education is the key to success. Staying informed and keeping others informed is how we'll make this expensive doughnut and dangerous hole go away.

Just as the sands pass through the hour glass, our first series blog reaches its end. Please join us with your comments, and especially with your political actions.