Schwitzer health news blog

Big business in snoring and apnea

I've been waiting for someone to do a story on the amount of attention and money that's being spent on snoring and sleep apnea, and a USA Today story comes closest to what I've been waiting for.

The story explains that Medicare approved $571 million in payments for devices called continuous positive airway pressure (CPAP) machines last year, up from $291 million in 2004. The story explains that "Spending could grow even faster under a new federal rule that makes it easier for patients to get the devices by testing for sleep apnea at home rather than in a sleep testing lab."

The story raises some important questions:

Some experts warn there is a potential for unneeded prescriptions for CPAPs. "Are people getting treatment they don't need?" asks Fred Holt of the National Health Care Anti-Fraud Association, composed of health insurers and law enforcement groups.

"Not everyone with a diagnosis of sleep apnea needs CPAP," says Holt, an ear, nose and throat surgeon. "Weight loss, avoiding alcohol and sedatives at bedtime or changing sleep position could eliminate the problem for some."

For others, treatment involves sleeping with a mask connected to the CPAP machine, which blows air into the patient's nose, helping prevent obstruction to breathing.

Until this spring, Medicare would pay for CPAP machines only if a sleep center diagnosed patients with apnea. New rules say a diagnosis can be made with a test taken at home.

Opponents say home testing is less accurate. "To be adequately treated, you have to make sure patients are adequately diagnosed," says Mary Susan Esther, president of the American Academy of Sleep Medicine, a trade group representing sleep labs.

Proponents such as William Abraham, a sleep expert and chief of the division of cardiovascular medicine at Ohio State University, say the change makes it possible for more patients to get tested.

"By allowing home testing, perhaps Medicare is opening the floodgates," he says. Yet given the problems of untreated apnea, "it's not only the right thing to do, but may ultimately prove to be a cost savings."

Still, any time you hear about more testing, and with financial incentives to test and to treat, you should know that the risk for abuse, and for unnecessary testing, treatment and spending is high.

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You wouldn't want to be a Republican Senator at a July 4th picnic

Bob Laszewski says "In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, DC, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts to pay for nixing it. Also at stake is another 5% physician fee cut set for January 1, 2009."

Read his thoughtful blog piece.

Sometimes journalists are criticized for covering the "horse race" aspects of policy discussions. Sometimes, like this, it can't be avoided.

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Medicare to pick up tab for more heart scans

Earlier this week, Merrill Goozner may have given us the spot-on scary political reality when he put his touch on the story of Medicare approving new payments for expensive heart scans. Excerpt:

I suspect there will be a lot more of these decisions over the next nine months as Bush administration appointees hoping to line up their next jobs grant top-of-the-wish-list favors to special interests.

The New York Times website reported Wednesday that the Center for Medicare and Medicaid Services has reversed a proposed policy to cut off paying for heart scans, which can cost $600 or more. The preliminary decision announced last December found no clinical evidence that heart scans identify heart disease any better than other non-invasive procedures, like a stress test. According to the paper:

Medicare’s initial proposal, which would have ended payment for the scans unless the patients were enrolled in studies to determine the technology’s effectiveness, had met with fierce resistance from the doctors who perform these scans and the companies that make the equipment. They strongly defended the use of these scans as an important alternative to traditional angiography. ...

Lobbying by docs and equipment makers. Pay first, evidence later. It's the American way.

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Call for transparency in Medicare's use of journals

U.S. Senator Charles Grassley (R-IA) has asked Medicare how it "assesses the content of the journals of science and medicine that it uses, in part, to make decisions about Medicare payments."

In a news release Grassley said, “I want to make sure the federal government relies on the best available science and that’s science that is peer-reviewed and free of bias."

In the letter to Medicare, he wrote: "Conflicts of interest have been proven in peer-reviewed studies to have a significant impact on scientific outcomes. Accordingly, it is important that scientific journals maintain policies of transparency and financial disclosure. ... With this issue in mind, it is troubling that few journals require authors to reveal who funded their research. Indeed, a 2001 study examined the top 1000 journals in science and medicine. The researchers found that only 16% of the journals had conflict of interest policies."

The Integrity in Science Watch program says that Medicare recently named 11 journals to the list of medical journals used to justify reimbursement for off-label use of cancer drugs. At least one of the journals did not require authors to disclose conflicts of interest and more than half did not require registration of clinical trials prior to publication, according to an Integrity in Science Watch survey."

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Kickbacks to orthopedic surgeons

From Integrity in Science Watch, a publication of the Center for Science in the Public Interest:

"Nearly 50 orthopedic surgeons, many affiliated with the nation’s top teaching hospitals, each earned over $1 million a year in consulting contracts and royalties from the five companies that make artificial knees and hips. The payment disclosures were posted on the companies’ websites last week as part of a $311 million anti-kickback settlement between four of the firms and the U.S. attorney for northern New Jersey. The complaint had accused the companies of using consulting contracts as an illegal kickback scheme to get surgeons to use a particular company’s artificial joints. ...

With seniors accounting for nearly 70 percent of the knee and hip replacement market, Medicare spent $16 billion on the procedures last year. A typical knee replacement costs $33,000, according to Medicare records. A spokesman for Christopher J. Christie, the U.S. attorney in Newark, said the investigation into the alleged kickback scheme is ongoing."

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Medicare beware

In his weekly newsletter, former U.S. Senator David Durenberger, now head of the National Institute of Health Policy writes:

“Private insurance giants United Health Group and Humana have priced 1.6 million seniors out of their current prescription drug plans. In some of the largest states in the country these top two Medicare sellers have submitted bids for 2008 which will require beneficiaries to go find other plans. …In traditional Medicare you wouldn't have this problem. It is not taking us long to find that private insurance competition is not necessarily the best nor the cheapest way for Medicare beneficiaries to access prescription drugs.

October's AARP Bulletin alerts me "Don't Fall for the Hard Sell." AARP is alerting its members to the downsides of private Medicare rather than Traditional Medicare (or "socialized medicine" as their GOP friends call it.) AARP's problem is with the hundreds of thousands of insurance agents who peddle these new plans and their prescription drug cousins to elderly folks used to dealing with Medicare as they and their parents knew it. These agents get paid a lot more for selling (the private “Medicare Advantage�) plans than drug or medigap plans, something like $250 to $500 per sale. …Starting in January, AARP will be selling its United Health/AARP MA plan. We'll find out then what kind of "trustworthy" agents we will be dealing with.�

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Medicare OKs marketing of private plans over objections

The Wall Street Journal reports:

"The federal government has given the go-ahead for seven health-plan sponsors to resume marketing Medicare private fee-for-service plans to older people after finding the sponsors in compliance with requirements.

The organizations had suspended their marketing of the plans in June after the Centers for Medicare and Medicaid Services (CMS) expressed concern about deceptive practices by some insurance agents. ...

Rep. Pete Stark (D., Calif.), chairman of the House Ways and Means Committee's Health Subcommittee, wasn't convinced that sponsors and CMS had done enough.

Rep. Stark, who has targeted Medicare Advantage funding, wrote that he has "seldom seen CMS respond to private fee-for-service plans' marketing abuses as they should, with civil penalties or expulsion from Medicare. ... Talk is cheap, and I look forward to action when private fee-for-service plans are again caught misleading Medicare beneficiaries."

He said that states should be able to oversee all private plans.

"These seven plans certainly weren't readmitted based on an open and transparent process that assured Congress or America's seniors that plans' behavior has changed," Mr. Stark said."

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Another Medicare Boondoggle

Earlier this week, Robert Pear of the New York Times reported:

"Private insurance companies participating in Medicare have been allowed to keep tens of millions of dollars that should have gone to consumers, and the Bush administration did not properly audit the companies or try to recover money paid in error, Congressional investigators say in a new report.

The investigators, from the Government Accountability Office, said the money could have been used to reduce premiums or provide additional benefits to older Americans.

Under federal law, Medicare officials are supposed to audit the financial records of at least one-third of the insurance companies each year. But the investigators said the Bush administration had fallen far short of that goal and had never met the “statutory requirement.�

Many have criticized this administration's promotion of Medicare Advantage plans through private insurers.

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Medicare rejects depression device the media helped hype

Wish I had a nickel for every story about vagus nerve stimulation that trumpeted it as a treatment for depression.

This week, Medicare rejected Cyberonics’ implantable nerve stimulator, saying the device, the VNS Therapy System, hasn't been shown to be necessary. The $25,000 device is already approved for epilepsy. Cyberonics wanted to expand its use.

Bloomberg News reports “The Food and Drug Administration approved the device in 2005 to treat depression, overruling 20 agency advisers who urged rejection.�

On the Cyberonics website the company boasted of dozens of news stories from across the country over the past two years, with headlines such as:

"Implant can relieve depression: VNS Therapy is proving beneficial."

"Omahan says she's proof device zaps depression."

"Emerging from the depths of depression."

"The Pacemaker for the Brain" is Saving Lives."

"Up from hopelessness."

"Implanted device helps fight drug-resistant depression - Giving new hope"

Among the media reporting the potential for the device:

U.S. News & World Report
Saturday Evening Post
Redbook
Reuters Health
Arizona Daily Star
San Antonio Express News
El Paso Times
Corpus Christi Caller Times
Toledo Blade
Omaha World Herald
Chicago Tribune
KSAT, San Antonio
WMUR Manchester, NH
WCCO, Minneapolis
KETV, Omaha
KUTV, Salt Lake City
KSL, Salt Lake City,
WBZ, Boston
WCBV Boston
WISN, Milwaukee
WKYC, Cleveland
KTBS, Shreveport
KOMO, Seattle

Each one of those news organizations owes it to their audience to play up the Medicare rejection of the device as prominently as they promoted the potential in the giddy glory days.

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Medicare not getting best bang for taxpayer buck

The U.S. Senate today will consider a bill that would correct one of the most short-sighted clauses of any legislation ever passed in this country - the part of the Medicare Part D legislation that kept the government from negotiating the best prices for the drugs now being sold to seniors.

A Star Tribune editorial summarizes some of the folly of the current law:

"When the Department of Veterans Affairs buys prescription drugs for veterans, it negotiates discounts from drug manufacturers. When Medicaid buys drugs on behalf of poor families, it demands the lowest available price. Yet when Congress added a prescription drug benefit to Medicare in 2003, it specifically banned the government agency from negotiating discounts on behalf of senior citizens and taxpayers.

That was an egregious and bizarre decision, and Congress should reverse it as soon as possible. ....

It is the biggest new federal entitlement since the Great Society, and it is costing billions of dollars in borrowed money. The least Congress can do is let Medicare get the best bang for the taxpayer's buck."

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60 Minutes on pharma influencing Congress - but why so late?

If you didn’t see 60 Minutes last Sunday (April 1), go to their website and read the story and watch the video link for the segment called “Under the Influence.� It’s the story of the incredible manipulation of Congress by the drug industry that took place to get the Medicare Part D legislation passed.

Excerpt:

The unorthodox roll call on one of the most expensive bills ever placed before the House of Representatives began in the middle of the night, long after most people in Washington had switched off C-SPAN and gone to sleep.

The only witnesses were congressional staffers, hundreds of lobbyists, and U.S. Representatives like Dan Burton, R-Ind., and Walter Jones, R-N.C.

"The pharmaceutical lobbyists wrote the bill," says Jones. "The bill was over 1,000 pages. And it got to the members of the House that morning, and we voted for it at about 3 a.m. in the morning."

Why did the vote finally take place at 3 a.m.?

"Well, I think a lot of the shenanigans that were going on that night, they didn't want on national television in primetime," according to Burton.

"I've been in politics for 22 years," says Jones, "and it was the ugliest night I have ever seen in 22 years."

Despite what a terrific piece this was, one wonders why it took 60 Minutes several years to catch up to this story. Some viewers wrote to CBS about how late this report came. Examples:

“Great story, AWESOME Story!!! Too bad CBS & 60 minutes waited over 3 YEARS after President Bush Jr. signed the bill into law to report on this. Perhaps if we the American people had heard this story back in early 2004, we would have made different choices when the 2004 presidential election came around.�

“CBS, where the hell were you in reporting this when it happened. Everyone else who was paying attention knew we were being screwed by this legislation, that it was just a give away to the drug companies. but like all (mainstream media), you were totally going to let it pass. Shame on you for taking so long wake up.�

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Medicare Advantage sign-up dirty tricks

On the listserv of the Association of Health Care Journalists, a journalist raises an important issue that we don't hear enough about. That journalist wrote:

"May I suggest that while Washington is obsessing about Walter Reed, the rest of us should be paying attention to what’s happening in our back yards in the run-up to the deadline for switching Medicare Advantage plans? In many areas, plans have contracted with independent brokers/agents to make a last push to persuade beneficiaries to switch plans. Many broker/agents who signed beneficiaries up for one plan in the fall (to begin Jan. 1) are now urging them to switch before the deadline; that way, they collect commissions twice. There’s a lot of misinformation being spread, a lot of dirty tricks. By the time we get around to reporting on it, the March 31 deadline will have passed and the misinformation campaigns will have been successful."

Have you heard anything about this from your news organizations in your market?

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Administration refuses to negotiate Medicare drug prices

We've written about Democrats' intention to address the Medicare drug benefit legislation prohibiting the feds from seeking better drug deals.

But the New York Times published a piece this week quoting administration officials saying they would not budge on the issue.

Health & Human Services secretary Michael Leavitt told the Times he did not want the power to negotiate drug prices. “I don’t believe I can do a better job than an efficient market,� he said.

“We are seeing large-scale negotiations with drug manufacturers, but they are conducted by private drug plans, not by the government,� Mr. Leavitt said. “A robust marketplace with a lot of competitors has driven down prices. It’s the magic of the market. To assume that the government, in our genius, could improve on this belies the reality of a complex task.�

To continue on the current course belies the reality that the U.S. is one of the few "super powers" that does not have its government negotiate drug prices. And there are many American consumers who are not entranced by the "magic of the market" that Leavitt levitates about.

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Dems win drops drug stocks

The Medicare prescription drug benefit legislation passed up a huge opportunity for the government to try to control drug costs. The legislation prohibits the feds from negotiating with drug companies for the best deal on all those drugs the government is now helping sell to seniors.

But the Washington Post reports: "Rep. John D. Dingell (D-Mich.), the presumptive chairman of the House Energy and Commerce Committee, said Democrats would try to close a gap in which Medicare beneficiaries must cover their drug expenses and push the government to negotiate with drugmakers for lower prices. He also vowed to remedy what he called the "large overpayment of insurance companies."

Dingell also said he would look into whether generic drugs were being kept off the market by deals among manufacturers and how drug companies were "creating new uses of questionable value" for old drugs nearing the end of patent protection. And he said Congress needed to scrutinize the Food and Drug Administration's licensing process. He took special aim at the dietary-supplement industry. "People are being killed" because of lax oversight, he said."

In response to this news, shares of big drug companies such as Pfizer fell the past two days. Drug benefits manager Medco Health Solutions Inc. has seen two days of Wall Street losses, as has Humana Inc., the second-largest provider of Medicare drug coverage.

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Medicare drug "doughnut hole" swallows seniors

"Every time somebody in Washington says what a wonderful benefit this is, I think they have to look a little closer."

That's what a consumer says in a Washington Post story about the millions of older Americans who are now hitting the "doughnut hole" in Medicare drug coverage. That means they've spent through the first wave of coverage are now in a hole wherein they must pay the full cost of prescription drugs - or stop taking them.

The Post reports: "Some seniors knew nothing of the coverage gap until they were hit with a bigger drug bill, advocates say.

Nine months into the program, as more and more seniors reach the threshold that puts them in the gap, many see it as a headache -- or worse."

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AARP - a prescription drug power broker

From former U.S. Senator David Durenberger’s Sept. 21 newsletter from the National Institute of Health Policy:

“AARP just launched a $500,000 advertising campaign to persuade Congress to allow Americans to buy prescription drugs in Canada. This is the same AARP that helped Republicans in 2003 pass Medicare reform legislation to provide a prescription drug benefit, but to prohibit Medicare from negotiating drug prices for Americans. This suggests it is AARP’s policy to require 26 million Canadians to do for Americans what they won’t allow 42 million Americans to do for themselves.

We do know now that one thing that drives AARP insurance policy is the Insurance Trust – separate from its policy board – which decides which insurance carrier will offer official AARP Medicare Supplemental and related products. UnitedHealth Group (UHG) owned that franchise before and after passage of the MMA, which gave the company a huge advantage over its rivals in the first year’s competition for Pt. D and Medicare Advantage plans. The same will hold true in the future unless someone in leadership at AARP insists on giving AARP member beneficiaries a choice of AARP- endorsed products. ….

No matter which way you look at it, the costs of prescription drugs are rising. AARP reported this week that the cost of the 200 most commonly-prescribed drugs for seniors has risen by an average of 6%. That’s twice the cost of living adjustment in Social Security. Plus the Medicare Pt. B and Pt. D drug co-pays are rising too. Considering the annual income of the aged and disabled with ongoing medication needs, these cost increases are painful."

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Seniors slamming into Medicare drug doughnut hole

The Minneapolis Star Tribune had an important story about seniors with Medicare drug coverage already hitting the "doughnut hole" in their coverage.

The paper reports: "Millions of Americans are nearing that gap. Nearly two-thirds of the 11.8 million beneficiaries who bought drug policies without gap coverage will hit the doughnut hole this year -- on average in the next few weeks -- according to the Kaiser Family Foundation. Simply put, the "doughnut hole" is the gap in the Part D benefit in which consumers must pay for all of their drug costs. In 2007, it will kick in after the first $2,400 in costs, with Part D coming back in to pay 95 percent of prescription costs beyond $5,451.25."

A state-sponsored senior help line reports calls from up to 450 seniors who have hit the hole and now need help paying for drugs. They report that many are shocked to hit the gap.

The paper portrays this as the second significant snafu in the program: the rocky start with much consumer confusion and now seniors worried and confused over hitting the hole so soon.

One woman, now paying $645 a month for her drugs and preparing to take a drug-buying bus trip to Canada, said in the story: "Congress was not thinking about people when it passed this law. It was thinking how they could make the drug companies and insurance companies even richer."

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Ballooning rates of balloon procedure in one Ohio town

The New York Times published a story showing the questionable variation in health care, "Heart procedure is off the charts in an Ohio city."

Elyria, Ohio does coronary angioplasties (often including the use of drug-coated stents to keep arteries open) at four times the national average, three times the rate of Cleveland, just 30 miles away.

This was all found through the valuable Dartmouth Atlas project, which, according to the Times, "also shows that the Elyria doctors have a higher than average tendency to perform diagnostic coronary angiographies on patients — the primary test that is used to detect blockages in the first place. 'People are just geared to be looking at things, and they find them,' said Dr. John E. Wennberg, who pioneered the Dartmouth data analysis."

The Times story concludes: " In the absence of any real monitoring or oversight, doctors in most places, including Elyria, have few incentives not to favor the treatments that provide them the most reimbursement. (A) San Francisco cardiologist said that the way physicians are typically paid — more money for more procedures — results in too many decisions to give a patient a stent.

'You can’t be paying people large sums of money to do things without checks and balances,' he said."

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Pharma windfall from drugs for poor people

Last week in the New York Times, Milt Freudenheim had a column headlined, "A Windfall From Shifts to Medicare."

"The windfall," he wrote, "which by some estimates could be $2 billion or more this year, is a result of the transfer of millions of low-income people into the new Medicare Part D drug program that went into effect in January. Under that program, as it turns out, the prices paid by insurers, and eventually the taxpayer, for the medications given to those transferred are likely to be higher than what was paid under the federal-state Medicaid programs for the poor."

Freudenheim also reminds readers that "in creating the federal Part D program, Congress — in what critics saw as a sop to the drug industry — barred the government from having a negotiating role. Instead, prices are worked out between drug makers and the dozens of large and small Part D drug plans run by commercial insurers. Since Part D went into effect, the pharmaceutical industry has raised the wholesale prices of its brand-name drugs an average of 3.6 percent. Although the actual amount spent depends on what each insurer negotiates, in many cases the drugs for those 6.5 million people who used to receive their medicines through Medicaid will cost more now."

What a great piece of legislation.

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Losers and winners in Medicare drug benefit

The Associated Press reports that the feds have "added 6,000 operators, quadrupled computer capacity for enrollment and will assist with more than 1,000 events in the week ahead as part of a final push for signing people up for the Medicare drug benefit" prior to the May 15 deadline.

Meantime, the Wall Street Journal has pointed out that "the massive effort has produced clear winners and losers among businesses and seniors. The early winners include some of the nation's largest health plans, which are peddling the drug coverage. After a rocky start in January, the plans have snagged roughly 15 million new customers and healthy government subsidies. Also buoyed: drug makers, which are reporting increased demand for some products used by seniors, such as drugs for chronic conditions. Many seniors are also giving the benefit good reviews, despite initial confusion about which plan to choose."

The WSJ also reports: "But not everyone is faring well. Many seniors have yet to sign up, which is leading to debate in Washington about extending the enrollment period. Medicare already has extended the deadline for people with low incomes. They stand to gain the most because of extra government subsidies, but their enrollment continues to lag. Dozens of smaller health insurers, meanwhile, are seeing only minimal enrollment gains, and independent pharmacists are criticizing the lower payments and suffering cash-flow problems. ... By far, the biggest winner in the race to sign up seniors is UnitedHealth Group Inc., which has used an alliance with AARP to help it grab more than 3.9 million new customers."

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Op-ed pieces slam Medicare drug "benefit"

American HealthLine, a publication of The National Journal tracked these op-ed pieces:

* Kansas City Star: "It is hard to believe that even the federal government could have done such a terrible job launching the new Medicare drug benefit," a Star editorial states, adding, "What a disaster." According to the editorial, the U.S. "needs a drug benefit that is easier for people to use, more logical in its coverage and far less generous to the drug companies" (Kansas City Star, 1/24).

* Springfield Republican: The Medicare prescription drug benefit "has been a disaster," and the "problems with the ... program cannot be easily fixed" because they are "systemic, not cosmetic," a Republican editorial states. (Springfield Republican, 1/22).

* Washington Examiner: The "new program was ... supposed to save the states money in matching funds," but "now state officials are fronting the money themselves, only to be told that they will have to go through the private insurers to get it back because Medicare officials have no statutory authority to pay them directly," an Examiner editorial states. The editorial adds, "No way! Medicare officials failed to make sure this overly complicated program was working properly, so it's up to them to make sure that localities are reimbursed for covering their mistake" (Washington Examiner, 1/23).

* Washington Post: "Many of the problems that have plagued the new Medicare drug benefit since its launch ... were not only predictable but predicted," a Post editorial states. Although the Medicare prescription drug benefit "could succeed -- or at least become cheaper and more efficient with time" -- the program "hasn't gotten off to a good start, and the politicians who legislated it should try hard to understand why," the editorial concludes (Washington Post, 1/24).

Opinion Pieces

* Maine Rep. Hannah Pingree (D), Bangor Daily News: "Congress and the president need to take a hard look at this new benefit and decide whether this plan, which benefits drug companies and insurance companies over American seniors, is working." (Pingree, Bangor Daily News, 1/21).

* Rev. Jesse Jackson, Chicago Sun-Times: "Hundreds of thousands of our most vulnerable citizens have found themselves cut off from prescriptions paid for by Medicaid and unable to obtain essential medicines," Jackson writes in a Sun-Times opinion piece. According to Jackson, "Seniors are paying the price in confusion, catastrophic drug cutoffs and escalating drug prices," as "American taxpayers pay for the costliest health system in the world, with the worst health results in the industrial world." (Jackson, Chicago Sun-Times, 1/24).

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MN Republicans criticize feds for Medicare Rx plan

Two Minnesota Republicans in recent days blasted the Bush administration's Medicare prescription drug "benefit" because of how it forced states to solve many citizens' problems with the program.

The Star Tribune reports that "hundreds of low-income Minnesotans have been affected by a computer glitch that mistakenly cut them off from access to subsidized drugs." Governor Tim Pawlenty said the feds' implementation of the program has been "awful." He also said, "I don't think it was well thought-out to begin with," calling the plan "almost mind-numbing" in design.

The Star Tribune also reports that Senator Norm Coleman (R-Minn.) called the program's problems "inexcusable" in a letter to Medicare administrator Dr. Mark McClellan.

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Mixed message on Medicare drug coverage

Market choices versus big government-run taxpayer-subsidized programs.

The Medicare drug coverage program is an experiment in trying to do both simultaneously, according to an essay in the Wall Street Journal.

An excerpt: "This market-friendly expansion of Medicare doesn't seem to be paying political dividends or attracting much consumer interest so far. 'This is a test case,' says Jonathan Oberlander, a University of North Carolina political scientist. 'It's a theory in search of population, and they've found the wrong population. A lot of what you're seeing is what happens when you try to turn seniors and people with disabilities into computer-linked consumers. It's insanity.'

Much of the problem may be that the drug benefit reflects political compromises that overlook lessons learned elsewhere about how consumers cope with an overwhelming array of choices."

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Bush's bewildering answer to Medicare confusion

President Bush this week told seniors that help is available to those who are confused by the number of choices for the new Medicare drug plan. Bush said, "Ask your son or daughter, ask people in your church, ask people in AARP, ask people in your community center to help you look at what's available for you." Bush said.

Note how suddenly it is non-government sources who are supposed to solve the confusion caused by a government program that some have called a boondoggle.

Meantime, the South Florida Sun-Sentinel reports that delegates at the 2005 White House Conference on Aging on Tuesday "sharply criticized" the new Medicare prescription drug benefit and suggested that it be "completely revised and administered by the government, not private companies." The delegates also said the federal government should negotiate directly with pharmaceutical companies to obtain discounts on prescription drugs, saying the resulting savings would eliminate the doughnut hole in coverage.

According to the Sun-Sentinel, Bush is the first president in the conference's history not to address delegates. Perhaps he didn't want to see how many of them were wearing buttons that read, "Fix Medicare RX."

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Medicare drug plan: greatest advance or boondoggle?

In his weekly radio address last weekend, President Bush called the new Medicare drug benefit "the greatest advance in health care for seniors and Americans with disabilities since the creation of Medicare 40 years ago."

OK, that's his view. Here are what some of the nation's newspapers think:

* Arizona Republic: In enacting the Medicare drug benefit, "Congress created a deeply flawed program of fiendish complexity with a price tag that is headed through the roof," a Republic editorial states. The editorial continues that lawmakers should "make some drastic changes, starting with allowing the government to negotiate better drug prices."

* Baltimore Sun: "It should soon be abundantly clear to lawmakers hoping for re-election next year that the drug benefit program desperately needs to be retooled," particularly to allow "Medicare to use the bargaining leverage of its 40 million beneficiaries to negotiate drug prices with pharmaceutical companies." According to the editorial, "The program as constructed is paying way too much for way too little in direct benefits to seniors." It continues, "Much more also needs to be done to make the benefit program comprehensible to its users."

* Chicago Tribune: The new drug benefit "is a runaway government entitlement of mind-numbing complexity, rammed through Congress with cooked numbers, launched at a time when the country can least afford it," according to a Tribune editorial. The editorial says that the "benefit is so confusing and so ineptly constructed that many seniors are likely to take a pass."

* Denver Post: The program could become "the mother of all federal boondoggles".

* Detroit Free Press: The new drug benefit is "hardly all-encompassing," and "[w]orse, the signup process is so complicated it's discouraging."

* Los Angeles Times: Medicare beneficiaries who enroll in the prescription drug benefit will "need an actuarial adviser, a personal pharmacist, a high-speed computer connection and maybe a sharp 12-year-old to help them navigate the Medicare Web site."

* Nashua Telegraph: The benefit is "off to a rocky start" because "the Bush administration and GOP leaders in Congress wanted to use 'competitive market forces' to deliver" the program, a Telegraph editorial states. The editorial adds, "Congress should be taken to task for developing a prescription drug plan that is so unclear and complex."

* Seattle Times: "The array of options and maze of forms" for the Medicare prescription drug benefit are "daunting."

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Questions about Medicare drug prices

Is it just coincidence that brand-name prescription drugs have been rising in price so much so soon before the start of the new Medicare drug benefit?

The Star Tribune reports that brand-name drug wholesale prices rose six percent in the past year, twice the rate of inflation and far higher than generic drug increases. John Rother of AARP is quoted: "Why are prices of brand-name drugs going up so much faster than generic drugs or inflation? Because the generics face competition, and the brands really don't."

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Medicare websites not ready for prime time

This week the feds launched two new tools on the Medicare Web site to help beneficiaries select prescription drug plans. The tools are supposed to help seniors compare deductibles, copayments and monthly premiums available under each prescription drug plan. Medicare administrator Mark McClellan says, "Right now (the Web site's) main use is for training and familiarity purposes for those who work with beneficiaries. It's not yet time to use the tool to make your decision."

Sounds like that's an understatement. The San Francisco Chronicle reports that some consumer advocates who tested the tools said that they were difficult to use. Volunteers at Senior Action Network in San Francisco said that the tools will confuse seniors who are not familiar with the Internet or computers. Gail Shearer, a policy analyst at Consumers Union, told the New York Times, "It's tough to use, even for advocates." Bill Vaughn, also a policy analyst with Consumers Union, told the Miami Herald, "All of the different volunteers need to roll up their sleeves and get ready for some massive education."

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Medicare misinformation

One of the best comedy shows of the new season is the handling of the Medicare prescription drug "benefit." The feds are sending out millions of "Medicare and You" handbooks that contain misinformation. The handbooks mistakenly say low-income beneficiaries will be able to enroll in any prescription drug plan available in their area without paying premiums. But the reality is that beneficiaries who qualify for the premium exemption only can take advantage of the additional financial assistance if they sign up for a plan with a premium at or below the regional average. About 40% of plans qualify to offer no premium, according to the Associated Press.

A Medicare administrator attributed the error to "inadequate proofreading."

This will only add to criticism of how confusing the new law and the new benefit will be for seniors. Senate Minority Leader Harry Reid (D-Nev.) said, "The administration has created a drug benefit that is so confusing, even the people running Medicare can't get it right." Rep. Sherrod Brown (D-Ohio) said he hopes Medicare "isn't serious that seniors can 'go online' to get the correct information," adding, "How will they know it's incorrect in the first place? Misinformation will turn a frustrating decision-making process into a complete waste of time."

(Credits to the Cleveland Plain Dealer, The Hill, and American HealthLine of the National Journal.)

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Medicare drug benefit "impossible to understand"

More than half of Medicare beneficiaries do not understand the new Medicare prescription drug benefit and do not plan to enroll in the program, according to a USA Today/CNN/Gallup survey conducted last week.

"The (poll) numbers suggest an abysmal program," Robert Hayes, president of the Medicare Rights Center, said, adding, "This benefit was designed to make it impossible for consumers to understand it." Vicki Gottlich, senior policy attorney for the Center for Medicare Advocacy, said, "People are very confused. Part of the confusion stems from all the variables. If you're going to get mailings from 15 different companies offering a different array of plans, you might throw it all in the garbage."

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Sad reflection on Medicare's 40th anniversary

This weekend marked the 40th anniversary of Medicare. The Washington Post offers a 3-part series, with part one headlined, "Bad Practices Net Hospitals More Money: High Quality Often Loses Out in the 40-Year Old Program."

It's an important look back, offering a chance to look ahead to a troubled program's future.

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"Brazen...false...misleading"

The KaiserNetwork.org posted the following excerpts from editorials around the country about the news that the Medicare drug benefit is now projected to cost far more than the Bush administration first estimated.

* Boston Globe: "This society ought to marshal the resources to keep Medicare a bedrock of affordable protection" for the elderly, a Globe editorial states, concluding that a tax increase "spread throughout the population would safeguard Medicare and spare millions from an old age of increasing hardship" (Boston Globe, 2/10).

* Chicago Tribune: The Medicare prescription drug benefit "was sold with false numbers, is badly designed and is far, far too expensive for the federal government to absorb," according to a Tribune editorial. The Tribune states that Congress "has to repeal this program" (Chicago Tribune, 2/10).

* Denver Post: The Bush administration's explanations for the "'lowball' projection" it gave for the cost of the new Medicare law "doesn't wash," a Denver Post editorial states. According to the editorial, "Congress should approve bulk purchasing" of prescription drugs for Medicare, and "lawmakers should ... remember the story of the Medicare cost estimates when they review Bush's plan to partially privatize Social Security" (Denver Post, 2/10).

* New York Times: With regard to cost estimates for programs the Bush administration "wants to sell," the "math isn't just fuzzy ... it is often downright misleading and deliberately so," a New York Times editorial states, adding that the cost estimate for the Medicare prescription drug benefit is the "latest example." According to the editorial, "Americans have to choose" whether they want a "social safety net that ... makes sure [the elderly] can afford adequate health care" or a "small government with a tax code" that protects "the wealth of the richest Americans at the expense of the middle class and the working poor" (New York Times, 2/10).

* Philadelphia Daily News: A bipartisan bill in the Senate that would repeal part of the new Medicare law to allow the government to negotiate lower prices with pharmaceutical companies and "introduce other protections for seniors ... might salvage some of the current mess" with Medicare, a Daily News editorial states (Philadelphia Daily News, 2/10).

* Providence Journal: As Medicaid and Medicare costs "are rising much faster than inflation" and governors become concerned that more costs might be shifted to states, "making nonessential medicines available to the elderly" -- such as those for erectile dysfunction -- "should be off the table," a Journal editorial states (Providence Journal, 2/10).

* USA Today: Medicare's prescription drug benefit is "unaffordable" without "an infusion of new tax revenue," a USA Today editorial states. The editorial continues, "Congress ought to revisit the law before it kicks in ... and figure out a way to target benefits to those who need them the most." The editorial adds that the "greater need is to abandon piecemeal approaches to the nation's mounting health care crisis and face up to the politically unpalatable need for a comprehensive solution" (USA Today, 2/10).

* Washington Post: The "phony, or at the very least unwarranted, outrage over Medicare costs underscores a real outage: the continuing, repeated brazenness of the Bush administration and its congressional enablers in manipulating budget windows to their liking," a Washington Post editorial states. The editorial concludes that predicting the cost of government programs and "the trajectory of the deficit is always inexact," but developing the "most honest assessment possible is a necessary ingredient of responsible policy-making" (Washington Post, 2/10).

* Washington Times: "In light of [the] considerable and mounting sum" of Medicare's prescription drug benefit, "lawmakers will have to broadly review the potential for waste" under the law and "consider if new legislation is needed to rein it in, even if this means more narrowly defining the meaning of 'medically necessary,'" according to a Washington Times editorial (Washington Times, 2/10).

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