tag:blogger.com,1999:blog-2584705757436511038.post4938561934266283001..comments2023-03-14T05:31:00.746-07:00Comments on Gen Y Healthcare: The Public PlanAndy Juanghttp://www.blogger.com/profile/02921959709575775344noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-2584705757436511038.post-66464397715910099782009-12-01T20:24:00.292-08:002009-12-01T20:24:00.292-08:00The reason why the donut hole has been controversi...The reason why the donut hole has been controversial is because of the assumption that the donut hole will force seniors to be smarter spenders. Seniors that don't fall into the donut hole have conditions that can be treated/managed with generics affordably. For instance, a senior that needs metformin or glyburide for his type 2 diabetes only needs to pay $4 a month for it. They can also take Januvia, a newer drug, that costs more money, as is just as effective for non-refractory patients. Doesn't matter what he picks, Medicare Part D will take care of the tab. Or, if a patient has depression, they can choose to take a generic SSRI for $4/month, or they can choose the new fancy but expensive SSRI/SNRI that will have the same efficacy but has a brand name going for it. Since medicare part D pays for it, the patient is going to be inclined to take the more expensive drug. On the flip side, a patient with crippling rheumatoid arthritis can enjoy a good quality of life if they take a biologic called infliximab. For $1650 every two-three months, you can live a life not hindered by painful arthritis. Or, a patient who has CML (a leukemia) can have a prolonged life expectancy if they go on Gleevec. All is great...if they can afford to pay $88 a day for it. Unfortunately, this means the patients will have to go into the donut hole; for many, this means they will have to stop taking the drugs after a few months. <br /><br />The crux of what I'm saying is that when a patient has a condition that requires medication, it's not the same choice as if I want to buy a new laptop or not. In the latter, if I can't afford the newest laptop, I will have to make do without one or with a lesser model, but it won't affect my life that much. I can always shop around for cheaper alternatives. For the former, it's either you take the meds, or you either die or live a very poor quality life. That medication may cost you thousands a year. I might be ok if I have a well-paying job, but if I'm retired, I'm in a bind. This is why the donut hole has received criticism; patients that need Medicare Part D the most are the ones that get shafted. Pharm companies have received billions because taxpayer money is used to pay for pricier brand name medications for easily manageable conditions though a generic can do just fine. When a patient truly needs a newer drug that becomes expensive, Medicare Part D fails because the whole point of it was to help patients with costlier bills make their ends meet. The only thing I like about Medicare Part D so far is that it does encourage generic drug usage. Otherwise, it needs to be redone. <br /><br />Last, on further research, I found out that the writer of the bill quit after it passed to become the head of the PhRMA, a pharma lobbying group. His salary is somewhere in the millions. In addition, 14 congressional aides quit their jobs to work in the pharm and medical lobbying industry afterwards.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-23331404652612819982009-11-25T12:53:09.895-08:002009-11-25T12:53:09.895-08:00@ Albert
I completely agree with you on the fundam...@ Albert<br />I completely agree with you on the fundamental issue of the trigger. Ironically, I think every liberal's fear about the trigger is that it won't ever trigger (ie. like Part D) and every conservative's fear is that it will trigger too easily. Square 1 right? On the surface it sounds like a great compromise, but then arguing about what the trigger itself will be puts everyone back at square 1.<br /><br />(For readers that don't know, Part D is the drug benefit for Seniors passed in 2003 and implemented in 2006. The actual benefit is a little bit odd. There is a small deductible up front, 75% coverage for the next ~$2,500, 0% coverage for the next $3,600 [called the donut hole], and 95% coverage thereafter.) The trigger that was written into the 2003 legislation was that if there weren't more than 2 plans in each of the 34 regions of the US, then the government could implement a public Part D plan. There were legitimate concerns that plans would avoid rural areas, but this turned out to be quite the opposite. There is thriving competition in the program, and the program is one of very few that has cost the government LESS money than expected and it has covered more people than expected. I think it is less about 'gaming' the wording vs. just genuinely being unsure if competition would exist. I think rural Senators wanted a little reassurance that the program would be available in their areas vs. Congress wanting a public plan to run the program.<br /><br />On the topic of Part D though, I do not think it has been criticized that much - it really is one of the few successful programs I can point to: lower costs for the government, drug benefit for seniors (when it wasn't available before), and a popular program/high satisfaction rate for seniors. The criticism has been about the donut hole itself, which I find focuses too much on the minority. The donut hole is doing its job - it is forcing seniors to become price-aware consumers of their drug spending habits. That encourages more focus on using generics, purchasing cheaper branded alternatives, etc. Sidebar: I'm actually quite incensed that the Pharma industry's "contribution" to healthcare reform is cheaper branded drugs in the donut hole where they are losing volume to generics already. If we want to lower costs, we should be encouraging generics - not branded drugs. Even if they didn't get anything back through more volume, $80bn/10 years is a complete joke for the industry - any pharma analyst will tell you that. To be sure though, there are definitely seniors out there that hitting the donut hole causes them a significant burden. Hopefully these people are part of the low-income subsidy program or are dually eligible for the Medicaid program, but if not, then these are the ones that fall through the cracks. They are not, by any means, the majority though. I do think eliminating the donut hole altogether is throwing the baby out with the bathwater. I personally don't view it as a bad thing.<br /><br />By the way, if anyone knows any actuaries that look at Part D and/or Medicare Advantage, then please let me know! I would love to talk to them.Andy Juanghttps://www.blogger.com/profile/02921959709575775344noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-17134417546604378432009-11-23T21:45:40.243-08:002009-11-23T21:45:40.243-08:00Doing some looking into on the trigger option, the...Doing some looking into on the trigger option, the left seems more happy with an opt-out plan rather than a trigger plan because though the trigger plan sounds like a great compromise, the true issue is the condition(s) for the trigger to happen. The conditions for the public option to take into effect can be so vague and strict that it can be written in a way so that it would be nearly impossible to "pull the trigger". In essence, a trigger option may mean no public option at all.<br /><br />Best example of the above is Medicare Part D. It was supposed to work on the same trigger principle, with the closure of the donut hole and reinstating some rules that would seem like no-brainers, like allowing gov't to negotiate with drug companies. The way it was written, the trigger never got pulled because the legislators gamed the wording so that it would be nearly impossible to reach the conditions. This is why Medicare Part D has been criticized so much; drug companies have basically been given taxpayer money by the billions due to this program, and when seniors truly need Medicare Part D, they almost always run into the donut hole.Unknownhttps://www.blogger.com/profile/16639153113109316442noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-13297828020024388572009-11-22T17:19:06.351-08:002009-11-22T17:19:06.351-08:00He's lying; this is Sammy JHe's lying; this is Sammy JSamhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-59153459932580706172009-11-22T17:17:42.689-08:002009-11-22T17:17:42.689-08:00I now see there is another Sam floating around the...I now see there is another Sam floating around the blog. I can only assume he is trying to steal my identity. To be clear, this is Sam L.Samhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.comtag:blogger.com,1999:blog-2584705757436511038.post-84892957533313970422009-11-22T17:12:04.008-08:002009-11-22T17:12:04.008-08:00Interesting summary and views!
-SamInteresting summary and views!<br />-SamSamhttps://www.blogger.com/profile/05243521631496638965noreply@blogger.com