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Until now, most older Americans have had to pay for their own drug costs. Medicare reform aims to change that, but there is also criticism of “Drug Plan D.” Many seniors are confused about the content and benefits of the new drug program. Photo: laif Since the beginning of the new year, seniors in the United States who have passed the age of 65 and therefore qualify for Medicare have been confronted with the so-called Drug Plan D – and in many cases remain without medication. The supplement to the Medicare program is intended to provide seniors with insurance coverage for their drug costs. Private providers U.S. President George W. Bush hailed Drug Plan D as “the biggest advance for seniors in health care” in the past forty years, the New York Times reported. The new program is intended to help contain rising health care costs, according to the administration in Washington. Until now, most of the roughly 43 million people insured by Medicare have had to pay for their own medications. With Drug Plan D, seniors will be able to insure themselves against this risk in the future. For a monthly premium of $35 and an annual deductible of $250, the new insurance will cover 75 percent of drug costs. Although the drug program is to be subsidized primarily by Medicare, it will be marketed and administered by private insurance carriers such as Aetna, Humana and United Health Group. Competition among private providers should keep costs down, the government hopes. But the new insurance program is controversial. Harry Reid, leader of the Senate Democrats, strongly criticized Drug Plan D: “The situation is that low-income Americans are begging for their medications and seniors are left without any insurance coverage. President Bush has bungled the Medicare program so badly that it no longer provides any benefit to the majority of seniors,” the senator said. Many Republicans have echoed the Democrats’ criticism. Since the drug program went into effect in January 2006, tens of thousands of Americans have not received the drugs they were promised from Medicare. The government has since told insurance carriers they must provide a 30-day ration of the drugs that participants would have previously taken. The socially vulnerable, moreover, should spend no more than $5 on a drug covered by the plan. There is a great deal of confusion among seniors about the content and benefits of the new program. An Associated Press poll found that two-thirds of Medicare policyholders did not understand how Drug Plan D works. Only 16 percent of respondents said the program was easy to navigate. Jean Finberg of the National Senior Citizens Law Center criticized, “Most of these people are in need of help. Our government is not protecting these people, and the new plan is too complicated.” Gary Karr, spokesman for the Centers for Medicare and Medicaid Services, acknowledged there were problems initially. He said this is a $30 billion to $40 billion program that will be a huge adjustment for many seniors. Problems with drug coverage Some 20 U.S. states have now declared public health emergencies. Many states have declared to make up for the shortcomings of the federally funded Medicare program, including California, Ohio, Illinois, Pennsylvania and the New England states. Their support primarily benefits the lowest-income. In California, initial projections showed that about 200,000 of the 1.1 million low-income Medicare enrollees had trouble getting their medications. Since the program began Jan. 1, many of the poor seniors have left pharmacies without drugs after being told that their co-pay could amount to $250 or more – on top of their monthly premium. Karen Dente by Eckardt Johanning[2] While no one is taking to the streets to defend the solidarity principle in health insurance after the recent health care reform in Germany, conservatives and Tea Party patriots in the U.S. are protesting loudly and media-effectively against a government expansion of health insurance. Eckardt Johanning explains why the system change is meeting with such strong resistance in the United States. When “Sicko,” Michael Moore’s documentary about the hardships and inequities in the U.S. health care system, was first shown in 2007, a member of a secret crisis team from the American Health Insurance Plans (AHIP) sat in the audience. The major U.S. health insurers-United Health Care, Wellpoint, Aetna, Humana, and CIGNA, which together generated a record $12.2 billion in profits from premiums and benefit cuts in 2009-fear that Moore’s film would turn the public against them and get them in trouble in Washington, too. Lobbying revealed At least that’s how whistleblower and author Wendell Potter, former public-relations chief of CIGNA, the largest private health insurer, tells it in his just-released book, Deadly Spin. All PR stops were to be pulled, hidden from public view, by AHIP’s “Strategic Communication Advisory Committee” to dissuade the U.S. public from considering a taxpayer-funded, government-run health insurance system for all. The public and the media were to extol the virtues of the free market health care and health insurance system in the United States. Had the film been more successful and had citizens actually demanded a better health care system, they were prepared to defame Moore personally. But that was not necessary. Instead, when Barack Obama’s administration set out to reform health insurance, citizens took to the streets to protest health insurance for all. Health insurance reform What was then passed as the Obama administration’s health insurance reform (Patient Protection and Affordability Care Act of 2010, PPACA) could have been called the “Health Insurance, Profit Protection and Improvement Act,” according to Potter. Indeed, it is clear that private, for-profit health insurers will gain from the reform in the coming years, as everyone is now required to join a health insurance plan. In addition, some of them will also be supported by state funds. On the positive side, far more low-income earners will be able to afford private health insurance, and Medicaid, the state health insurance for the poor, will be expanded at the same time. In addition, pre-existing illnesses or accidents will no longer be able to be cited as a reason for refusal when changing insurance or applying for new coverage. In small and medium-sized businesses, tax breaks are to ensure that these businesses can offer their employees cheaper health insurance rates than are available on the open market. And the infamous non-reimbursement of drug costs in the Medicare program (health insurance for retirees aged 65 and over) is also to disappear. This had led to retirees currently having to spend an additional $500 to $3,600 per year as copayments for drugs. With the new PPACA law, the system of a “Public National Health Program for All” favored by progressives and liberals is off the table. The government did not want to enter into a major conflict with key players in the health care system. The large private insurers thus became players in the reform discussion. But even that was too much for conservative Republicans and large segments of the population, and Obama’s reform was characterized as a “rapid march to socialism” and “class warfare from above.” Behind this was, among other things, a secret and perfidious campaign by U.S. insurance groups (see AHIP) to denounce the reform and its advocates and to mobilize right-wing opposition forces so that they would stay in the game in the end – at least that’s how former public relations worker Potter describes it. Opinions on the reform differ The November 2010 elections, heavily influenced by the Tea Party Patriots (a populist protest movement, with right-wing libertarian features, close to the Republicans and named after the “Boston Tea Party”), have led to further escalation and demagogic transfiguration and confusion. Thus, “Stop the Government Takeover of Health Care” is now being used to warn against the “Tyranny of Government.” Republicans and Tea Party patriots want to undo Obama’s health care reform through town meetings, neighborhood meetings, phone actions, lawsuits and legislative initiatives. However, the nationwide rollout of universal health coverage will be constitutionally unstoppable, even though individual states have already successfully sued (in some cases) against the law. Between April and November of this year, about 40 percent of citizens expressed approval of health reform, just as many were opposed, and 20 percent remained undecided. There are many reasons for the negative opinions. “Big government” is what most say: To them, government is too sprawling, corrupt, expensive and inefficient. Here’s the reality The facts and figures on the U.S. healthcare system are sobering: – The Centers for Disease Control and Prevention estimate that in 2006, around 54.6 million people in the U.S. had no health insurance. And the numbers are rising in the current economic crisis. Many of the uninsured are blue- and white-collar workers who cannot afford insurance because of high membership fees. But even though the percentage of uninsured has risen to 15 percent of the population – as many as 43 percent of the uninsured have above-average incomes of $50,000 or more (Cologne Institute for the German Economy). – The average cost of family health insurance in 2009 was $13,375 per year, while the average annual income for minimum wage earners was just $11,500 (2008). – The U.S. is one of the countries with the highest health care costs, but lags far behind other industrialized nations in public health statistics. In some areas (rural health, immigrant health, infant mortality, etc.), they are comparable only to developing countries. – The total cost (circa $8,160) of health care in the U.S. per capita is higher than that of eight European countries combined – but the government exerts little influence on cost origination and trends (this is likely to change under PPACA). – Health reform continues to leave 23 million people in the U.S. uninsured over the next nine years. This will result in 23,000 preventable deaths per year – according to Physicians for a National Health Program (PHNP). – Millions of middle-class Americans are forced to spend up to 9.5 percent of their income on private health insurance, but it covers only up to 70 percent of their health care costs. – Bureaucratic costs at private insurance companies currently account for about 31 percent of premiums. Individualism and freedom Victor Fuchs of Stanford University points out in an article in the New England Medical Journal that in the U.S., the share of government health care costs has risen steadily over the past 50 years (to nearly 50 percent in 2007) and is likely to exceed the private share with health care reform. Countries with government health insurance, for example Denmark and France, spend far less per capita but still have better health indicators. However, Fuchs also says that higher health care costs have benefits as well, such as shorter wait times, shorter distances to treatment locations and more attractive facilities than in countries with national health care systems. Why the U.S. public cannot embrace the overall benefits of better distribution of resources and lower costs, he believes, is probably due in part to the special role of individualism and revolutionary history in the U.S., with its emphasis on “life, liberty, and the pursuit of happiness”; and to the fact that for centuries there was no common language, history, and culture. Illness should be a private matter Nonetheless, the excitement in the U.S. about the reform is met with astonishment in Germany. While the tax-financed insurance system for everyone seems desirable from a German point of view, for U.S. citizens the coming state regulation of insurance with private health insurance companies is already a descent into socialism. People do not want to rely on the state to finance and control treatment costs in order to avoid its interference in matters of life and death – when and in what cases, for example, will expensive treatment be approved? It is easier to trust in one’s own strengths to master crises. Illness is a private matter, and leading one’s own life without government paternalism means freedom. Medicaid and Medicare Medicaid as health insurance is a social welfare-like benefit and requires a significant impoverishment of the needy person. Medicaid is funded equally by the states and the federal government. The program is operated largely from tax revenues and is means-tested. In 2001, the program provided health benefits to 46 million citizens. Medicare is a basic pension insurance program administered by the state and financed by payroll tax contributions. It is comparable in part to the German long-term care insurance system. Any U.S. citizen age 65 or older and citizens with a disability are eligible for certain cataloged basic benefits at specified rates. The insurance includes a minimum reimbursement for hospital treatment and outpatient care. In addition, people can take out supplementary voluntary insurance for outpatient treatment and medicines. The reform is expected to significantly reduce the costs of both systems. Comparison of the “single payer health insurance for all” initiative Physicians for a National Health Program (PHNP) and the enacted healthcare reform in the USA: Patient Protection and Affordable Care Act (PPACA). National Health Program (PHNP) Membership: unrestricted, guaranteed health insurance membership all U.S. citizens (including immigrants) included no health insurance premiums or copayments free choice of physicians and hospitals Financing and costs: taxpayer-funded no increased costs over existing system savings from lower administrative costs benefiting the uninsured cost control through centralized hospital budgeting and capital investment emphasis on primary care through general practice PPACA Membership: no health insurance exclusion due to pre-existing conditions/accidents Requirement to belong to one of the private health insurance plans Government support for health insurance premiums or copays based on income Requirement to choose physicians within a limited health insurance network Financing and costs: increase in Medicare contributions for incomes over $200. 000 dollars more money for needed services through increased enrollment of young, healthy insured Health insurance coverage by employers remains unchanged Costs are oriented to the market Savings through Medicare reform/reduction of physician cost/hospital reimbursements Savings through technological advances, e.g. electronic medical records & cost reporting, insurance fraud reduction A version of the article including references and tips for further reading can be found at www.mabuse-verlag.de/aktuelle Edition/189_The_US_Health_Reform_Johanning.pdf. [1]Source: Mabuse, MD, Issue 189: January/February 2011, pp. 38-40; reprinted with kind permission of the editors and author. [2]Author information: Eckardt Johanning , born 1953, is an occupational and environmental physician and works as a practicing physician in New York, USA, www.johanningmdpc.com Back Amazon Yearly Fee.

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