Category Archives: Medicare

TPP/Cuts to Medicare/Increased Drug Prices

Trade agreements seem deadly dull to most Americans and we often feel we have little, if any, control over agreements between giants actors like nations and corporations. Trade agreements are written in technical language that is denser than most reading matter and does not exactly thrill the average reader. Economics is one of the more arcane topics. It seems simple to anyone who keeps a household budget but we also understand that a national economy, or, even worse, a global economy happens on an entirely different plane of complexity.

Even if we could read an agreement like the Trans Pacific Partnership agreement now being hammered out and soon to come up for a vote (which we cannot because it is secret) we would have even less ability to predict the effects of this agreement on our economy than the people who have negotiated the agreement (often politicians), and their predictions have almost as little value as ours.

We may not understand the TPP, or fast track which apparently has to do with the process for passing the agreement in Congress (without much Congressional and no public input), but we do understand how much our Congress people like to attach little surprises to bills that are coming up for a vote. In this case, if you have been paying attention perhaps you have heard that Republicans (who seem to be in charge of the nastiest surprises these days) have tacked $700 million in cuts to Medicare on to the bill for fast tracking the Trans Pacific trade agreement. The fast track bill is known by the acronym TAA.

You probably remember that the Sequester mandated cuts to Medicare for each of the next ten years. We should be screaming bloody murder. We should at least be writing and phoning our Congress people. Why are Republicans cutting Medicare just as more and more people will need it? Is it possibly because wealthy Republicans have decided to wean off any and all who are dependent on government so that we will stop bothering them to pay taxes?

These cuts will hurt our Medicare care and they will force our doctors to absorb more cuts when they are already being asked to drastically cut their fees.

The TPP and fast track also suggest that we make some new rules about prescriptions that will raise drug costs which are already fairly astronomical. This amendment to this trade agreement also promises to impact negatively on either the pocket books of American citizens who can still afford to buy the drugs, or the health care of Americans who cannot afford the costs. These new rules which threaten to increase drug costs offer another matter about which we should write our Congress people.

Admittedly one of these sources I will quote for you is a left-leaning source. I tried to fact check this but have not, so far, received an answer to my request. But if these are secretive actions being taken on the down low by Republicans we cannot expect the right wing to give us the scoop which would explain the dearth of articles from the right on this matter.

I hope that after you are aware of this info you will write or call your representatives in Congress and tell them either to vote against the TPP and fast track or to make sure that these “poison pills” are removed from the bills or documents before they pass.

Medicare cuts in the TPP

The Republican assault on the TAA incurred the wrath of nationwide health providers who rightly object to the GOP ‘fix’ because it includes a 0.25 percent cut in Medicare payments. According to the Congressional Budget Office, the Medicare payment cut amounts to $700 million. The amount, regardless how much, is just another assault on the elderly, hospitals, physicians, nursing homes and home health and hospice providers who have already been forced to absorb hundreds-of-billions of dollars in cuts to the Medicare program in recent years. The latest GOP assault was in 2011 with the 2 percent cut in Medicare payments as a result of the Republicans’ precious sequester. The 2 percent cut will continue for eight more years unless Republicans find it in their black hearts to end the sequester cuts once and for all.

A group of healthcare providers issued a letter to legislators on Tuesday signed by the American Hospital Association, the American Medical Association, the American Health Care Association (skilled nursing trade group) and the National Association for Home Care & Hospice. The letter “urged Congress to strike this provision from the legislation. Reductions to Medicare payments have real impacts on patients and providers. Additionally alarming is the use of Medicare cuts to pay for non-Medicare related legislation, a precedent that we believe is unwise.” It is also heartless to include Medicare cuts to an international trade deal written by corporations, but no-one has ever accused Republicans of having a heart; or being unafraid to find unrelated reasons to cut Medicare, food stamps, housing assistance, or unemployment benefits in other legislation.

To make the cost of the trade bill just a little more painful for Americans besides those that will lose their jobs, the elderly who will lose out with Medicare cuts, and healthcare providers facing another .025% cut in Medicare payments, the Republican adornment to the TAA extension includes damage to struggling families with cuts in the child tax credit. Republicans could no more explain why cutting the child tax credit is crucial to ‘fast-tracking’ the TPP than they could cutting Medicare, but it is safe to say they just love hurting Americans; particularly in advancing the whims of corporations.

How Trade Agreements Could Affect Prescription Drug Costs

The United States Trade Representative (USTR) is pursuing language in trade agreements, including the Trans-Pacific Partnership (TPP) and the Trans-Atlantic Trade and Investment Partnership (T-TIP) that could restrict the ability for the United States and other countries to manage prescription drug and medical device costs in public programs.  Proposals the USTR has sought in trade negotiations include:

  • Limiting the authority of governments to set payments or reimbursements for prescription drugs in their public programs, such as Medicare and Medicaid.  While it is not the intent of the USTR to undermine the Departments of Defense and Veterans Affairs’ exiting authority to control prescription drug prices, final language in the agreement could be used to attack such programs.
  • Forcing countries to extend lengthy patent protections for pharmaceutical drugs.  As long as a patent is protected, a generic cannot be sold.  The patent holder is the only one allowed to sell a drug and can therefore demand a monopoly price for it.  Lengthy patents drive up the cost of prescription drugs.
  • Allowing countries to grant twelve years of regulatory exclusivity for the first registered biologic medicine.  The US is the only country that allows long periods of extra-patent exclusivity to drug manufacturers.  This proposal could block the president’s plan to reduce the exclusivity period for biologic drugs from twelve years to seven years or preclude restoring previous policy in which biologic drugs were not provided a period of increased exclusivity.

Establishing “investor-to-state dispute settlement” (ISDS) systems in trade agreements to allow investors to challenge laws and regulations which they allege will hurt their profits.  Drug companies could use ISDS to challenge formularies and preferred drug lists, discounts and rebates and other policies in public programs that pay drug companies less than the price they demand.

This is the view from the cheap seats.

By Nancy Brisson

You Lost!

We have a box on our paychecks where money is taken that is “supposedly” dedicated to Social Security. We have another box which shows monies deducted from our pay and “supposedly” dedicated to Medicare. Yet when we see graphs on our news media, Social Security and Medicare are included as regular budget items.

Is Washington merging all our tax money, dedicated and otherwise into one budget stream? This is not the way citizens perceive the situation. But since you all keep harping on cutting Social Security, which we are told is not broke yet, then the money merge of dedicated funds with ordinary taxes must be the case.

Medicare, you tell us, costs more than we pay in. We can accept that. We have seen the explosion of costs in health care. Show us how much we pay in and what you have to pay out and the difference between the two. We were hoping you could make up this difference with cost-cutting and fraud prevention. If you can’t we can accept that some changes will have to be made to Medicare. I like the broader-base/means testing ideas best.

Why is our Social Security in jeopardy right now? We still have a little time to solve this one. You need cuts. There are lots of other places to cut. You snatched that money out of our checks with complete regularity. Don’t expect us to kiss it good-bye without a fight. We really need to be able to retire as was promised.

Save Medicare and Social Security for one year. See if the economy starts to make a stronger recovery. Spend that year presenting your plans for these two programs to the American people. Let us vote for them on-line. Do what must be done with these two programs next November (2013).

In the meantime why are we still listening to the same “blame game” rhetoric from Eric Cantor and Paul Ryan who are holding the Republicans feet to the fire when they lost the election!You lost GOP — your approach lost; let the President try his way which is the way America chose! I don’t really think going over the cliff is such a bad option. It will be painful. It will hurt the economy. But it represents a fair approach to budget cuts which we might not have the guts to do otherwise. So if you can’t support Obama’s plan just forget it. We will all hold hands and go over the cliff together.


Every time the President asks Congress to raise taxes on the wealthiest Americans, John Boehner says no, offers up some of the deductions that currently lower taxes for wealthier Americans, and then drops the “entitlements” bomb. Not only will he not give the President what he wants but he demands that the President sweeten the non-deal with cuts to “entitlements”. Is John Boehner high? Has he been to that other Washington, the state, recently? Americans understand that we do not need to cut “entitlements” before December 31st. Cuts to “entitlements” do not have to be a part of fiscal cliff negotiations. The Republicans are just addicted to fear-mongering. They want the American people to blink first. Even if entitlements must be reformed, which a healthy economy might render unnecessary, we can wait until next year to do it.

Congress must stop believing that raising the age when “entitlements” become available is the answer to reform. This is just a quick and dirty approach which pays no attention to the realities of when people are actually “forced” to stop working. Unless employers find that they can keep older adults in the work force until they are 67, raising the age of eligibility for retirement benefits will create a coverage gap that will swallow up many hard-working people. The approaches that look at cutting costs and broadening the base of contributors along with means testing look much more promising.

Decide what to do about the Bush era tax cuts and raise the debt ceiling before the end of December. Finish the rest of this in the new year.


Avoiding the Demise of Senior Programs

Seeing that Grandma and Grandpa live their senior years with some sense of financial security has been one of the landmark decisions that grew out of the Great Depression and that set America aside from other nations. In fact, this idea has been copied around the world. It is not a detriment to our “exceptionalism”; it is a key element in our “exceptionalism”. Social Security and Medicare are different from other government safety net programs because they were set up to be paid for by those who participated in them, and everyone who worked had to participate. These programs were never intended to be private sector (or for-profit) programs. We would supposedly fund our own future financial security.

Now we are told, and we can see for ourselves, that our financial security is in jeopardy. We do understand what our Congress people are telling us. In this economy these programs are not paying their own way; they are a drain on our federal budget and, in their current form, are unsustainable. After we get over our anger at the poor planning and lack of foresight shown by our representatives in Washington we will obviously have to tackle the issue of where to go from here.

Do we give up on financial security for our seniors? Do we go back to extended families that care for their own senior members? Will this renew the popularity of the family and stop the trend to put off or avoid marriage? Do we give the private sector control over senior security and turn it into a matter of profits, bottom lines, and cost effectiveness where prices will rise and rise, or where the standard of living for seniors will rely on the whims of the stock market? Will we find some kind of workable public/private compromise? Not one of us is sure about what we should do in this situation, but any senior will tell you that, although they would be open to a financially viable revision, they would not be open to the abandonment of these programs, even if it would only affect their offspring.

I am not a fan of AARP. They are basically an insurance company and they have made a lot of money selling insurance products to seniors and accepting donations to the AARP Foundation. However, since we are already “paying them” to find solutions to the difficulties senior safety net programs are facing, perhaps we should genuinely consider some of the solutions they have been suggesting. They have held many meetings with seniors and many of these seniors have a background in finance. Despite their profit motive, they represent a sort of senior brain trust. Perhaps we could take an informal internet vote on the options AARP has come up with and see which option is most popular. Possibly we could get one of those Congressional Budget analyses of each of the options that they have described.
As for Medicare, Paul Krugman agrues in this morning’s NYT for keeping the Medicare intact and avoiding “Vouchercare” and he does a much better job of it that I have probably been able to do. I feel that the Affordable Care Act should be given a chance to function and that it may be just to ticket to save Medicare in its current form.

Why the Mitt Romney/Paul Ryan Plan Won’t Work

What’s wrong with vouchers for Medicare for American’s under the age of 55. Maybe nothing. Maybe a lot. We are hearing that everyone would be handed a voucher that would pay for the second most expensive Advantage Plan (offered by private insurers.) We just had a system that depended on private insurers. It did not cover people with a “pre-existing condition” (that’s pretty vague, a pimple could be a pre-existing condition), or people who needed expensive long term care, or people who were too poor to buy insurance, or people who were unemployed. Eventually insurers started to place “lifetime caps” on patients who were too risky and pricey to insure. People were turned into things, like houses, trucks, cars; or disasters like fires and floods. Since private insurance companies must make a profit, they will always (and should always) try to minimize risk. How do you minimize risk in the case of human health? You make crazy rules that are more and more restrictive like rules about what we can’t do if we want to be covered (i.e. can’t smoke, can’t eat sugar, can’t eat fat, can’t gain weight, can’t drink soda) – and where will that end?
The voucher plan didn’t originally include a public option, but I hear it does now. With the newest incarnation of the plan if you wish you can keep your government Medicare insurance. Critics of this plan suggest that this is where you can expect to find everyone who can’t meet the requirements of the private health insurers. This will not make the public option look very appealing to those who are essentially healthy seniors and they will stay away from it in droves, putting private insurers right back in their very powerful and profitable driver’s seat where senior health care is concerned, and will give them, once again, a monopoly on the health care business in the U.S.
I am not against business. I am not even against profits, although I am opposed to gouging. I just can’t remind everyone enough about how long it took us to learn that unregulated capitalism, while supremely prosperous for an individual who is successful in business, will always have a tendency to abuse workers in order to buck up profits. There is no moral imperative in captialism, only the motive to turn a profit. I also am not saying that that are not moral capitalists – there are, but the practice of capitalism does not require that the Golden Rule be applied.
Interestingly enough, Gail Collins, writing on the opinion page in the New York Times, reminds us that the real loser in the Ryan plan is Medicaid, which will change beyond recognition. In the interests of smaller federal government Ryan suggests that the federal government give “block” grants to states for Medicaid and that states then devise their own Medicaid programs. Many people think this would be OK because they believe that only poor people use Medicaid. However, this is not the case. When seniors need long term care, nursing home care, care for serious or final conditions they are switched from Medicare to Medicaid. This means that any one of us could be subject to the whims of our own state’s government when our health is likely to take all the fight out of us and leave us as possible victims. Right now states are experiencing less flexibility in dealing with their financial issues than we find available at the federal level because they can’t print money. If you hand them a block of money without a lot of regulations for how it can be spent, would you like them to have control over your health care, right when you are most frightened and sick?
There is much to consider in this decision. Everyone agrees that we must do something but just because Paul Ryan has come up with a ready-made plan does not mean that it is the right plan for Americans. It will put us not just back where we started, but we would be in worse shape than previously if you add Medicaid into the picture. We have a little time to look for other options. I always wanted an all public option, but I am coming to believe that right now this would leave too many people unemployed to be an appropriate choice. In spite of the fact that Republicans see Obamacare as anathema, Obama still left the private insurance companies with a big role in our health care. Obamacare seems bipartisan in that it is a plan that requires that all parties compromise their health care views, and in that it tries to walk a middle line between public and private.

Becoming Our Own Charity

When our elected Congress people first started talking about things like “small government” and getting rid of “entitlements” because they are not part of the business of the federal government I was aghast, as I believe many of us were. I still resent that the opponents of the safety net played the “destroys initiative card” and the “creates lazy citizens card” and the “actually a form of oppression card”. If you want small government at least be honest about your motives; no need to insult the “have not’s”.
I do believe, in these times of big population, that a small government movement is inappropriate. I do not believe this is any moment, after the shenanigans of the big banks and Wall Street and the mortgage market to argue for total “laissez-faire” capitalism. This is not at all logical. “We messed up when we were regulated so you should take away all regulation.” Did you think the American people weren’t paying attention? This message that American regulations and tax codes are strangling business would make some sense if we could shrink the American economy enough to compete with China and India, et al. But why would we want to do that in the first place and could we even if we really wanted to? We are used to our creature comforts and we are accustomed to our standard of living. We cannot become a China or an India. We cannot shrink our economy enough to tempt back the manufacturers who have left us. And we cannot pretend that when they left us they did not hurt our economy, but they did not hurt it enough to make us competitive. It is not regulation that is driving business away; it is not tax codes; and it is not labor unions. It is the bottom line, it is the profit factor and it will take time for the advantage to swing back in our direction.
It is, however, quite possible that regulation and tax codes are hurting small businesses. It is possible and probable that in these straitened times, benefits like health care and pensions are hurting the willingness or ability of entrepreneurs to begin small businesses. I believe that we could work to take some risks out of business start-ups and we could do better with encouragements to venture capitalism. But, just because benefits are serving as obstacles to doing business does not mean our society can afford to do without them. Perhaps we do need to separate health care from employers. If health care is to be available to all, why should employers have any part in it? It challenges a workers right to privacy when an employer sponsors health care. Although the employer should not have any access to an employee’s health information it sometimes must be revealed so leave arrangements or similar issues can be addressed.
What seems to be true, and what I am hearing more often these day, is not that “entitlements” turn us all into deadbeats (since this is, surprise, surprise, an unpopular argument); it is that “entitlements” or our safety net is untenable. We will not be able to afford to keep it. These benefits we all rely on are unsustainable and they will bankrupt our government. I’m not sure it this is fact or hyperbole, but almost everyone from the most strident extremists to perfectly reasonable sounding moderates seems to agree that Medicare, Medicaid and Social Security certainly need some tweaking.
I keep thinking that we could set up some kind of citizen’s agency to collect and hold donations by people who wish to save these programs and to keep them open and operational for generations to come. It could be a sort of Red Cross program to rescue our safety net whenever it fell on difficult times, A Citizen’s Safety Net Emergency Fund run by financial people, economists, or CEO’s in the private sector who were directly elected by citizens in an internet voting procedure. Of course one problem with this would be to be sure our government wouldn’t “borrow” from the safety net because they knew the funds would be replaced. I’m sure that we human beings could come up with some very creative ways to abuse such an agency. Our clever brains are not always backed up by scruples. Anyway, that’s my basic idea for what it’s worth. I would leave it for great legal minds to write the necessary safe guards into the plan. We could become our own charity.

How Will Democrats Save Medicare?

Paul Ryan, our very serious Republican extremist (who is looking a little less possessed and edgy these days) has designed a budget which includes all the usual GOP requirements – no tax increases (in fact it suggests only two tax brackets, 10% and 25%) and it cuts the corporate tax from 35% to 25%. It also includes unspecified changes to unspecified loopholes. Mr. Ryan would restore all the monies that Obama cut from the military and would put the military back in the active mode that is it currently expected to stand down from. He would change Medicare completely and give it to a private entity to manage. He would subsidize our payments to this insurance conglomerate (with our own money) and, if I remember correctly there would be an oversight group.
This plan is not new. It includes all the delights the Republicans have been promising us. Unfortunately this budget makes us feel like this is Paul Ryan’s government instead of the people’s government. Fortunately we are assured it should not pass in the Senate.
Of course, I don’t favor this budget and I am crossing my fingers that it absolutely will fail in the Senate. However, it does bring up the constant worry we all have about Medicare. Everyone tells us that Medicare cannot continue forever as it is. I often think that I would like to see a version of Medicare for all of us. Right now, with such high levels of unemployment, putting everyone in the health insurance business and everyone who supports the health insurance business out of work is probably not a good move. Obama’s Affordable Health Care Plan was not really designed to save Medicare; it was designed to insure the uninsured. Perhaps the savings we get from this plan will be enough to rescue Medicare, but we’re not feeling it and I think we need to hear many more specifics about this from the Democrats. They need to reassure us by sharing how the “Affordable” plan will save Medicare or they need to come up with their next installment of a plan that will save Medicare. If they don’t speak up people might think the Republicans are the only ones who have any idea what to do, even if their plan will include forcing women to rediscover primitive ways to take care of their business.  You know what they say about “a bird in the hand”.  Where are the Democrats? This might be a good time to speak up.

Solve the Debt – Ditch Medicare

This is getting pretty scary. The discussion about how to pay off the national debt is zeroing in on seniors. Already there seems to be a consensus that the only way to undo the debt is to end Medicare. I have had a hunch all along that our government would go there. I wonder how bad it will be if we don’t have Medicare? Our fearless leaders won’t have to worry about what to do about the baby boomers – they will just cut them loose.

America will become a lesser place for everyone if we have to break our contract with older Americans. At first the discussion centered on dropping only seniors who are now under 55. That discussion lasted about two days before someone cried, “unfair; it has to include all seniors.” Is there anything fair about this at all?

Yes, let’s take the people who have fixed incomes. Let’s take the people no one wants to hire. Let’s take people who have already been gut-punched by the recession and let’s use them to balance the budget.
We can all see that Medicare is very expensive. We can all see that it is not sustainable in its current form. We have also already accepted the dangers of letting the insurance companies handle health care without oversight. Just turning us all out into the same old health insurance market with a voucher in hand is not an acceptable alternative. Is this backlash from the insurance industry? They would be very happy, I’m sure, to have all the new controls taken away.

For one thing, if you want to change the game plan you certainly need a transitional period. Even the insurance companies got four years to adjust. My mom is 93. She did not work outside the home. She raised eight children and she babysat. She lives on a tiny budget. What will she do without Medicare? She does not do well with changes these days. If you hand her a voucher she will file it in her desk and think about it for about a year, and we won’t be able to budge her. Will we take away her Medicare? The way you handle this is very important to a very big number of vulnerable Americans so take your time, do your due diligence, and get it right.

I still believe the American Dream takes a real step backward on the day this deed gets done.