American Elephants

There is a commercial airing now on the radio, attempting to reassure Seniors that Medicare will still be wonderful, don’t worry, all is well.  It consists of a conversation between a couple and the woman tells the man how wonderful the new changes to Medicare are, for now Medicare pays 50% of the cost of all drugs in the “donut hole.”

When George W. Bush got the drug benefit added to Medicare, many Seniors celebrated, and many budget hawks groaned —  the last thing we needed was a new entitlement.  We are now in trouble with the entitlements we have, and the huge numbers of baby boomers now beginning to reach retirement age mean that action on entitlements is not a choice, but a necessity.

That said,  the drug benefit included incentives to keep the costs of the new benefit down.  The entire thing, so far, has come in significantly less than estimated — something new and novel for any government program.

The drug benefit does not tell you which drugs you must take, but it separates them into categories.  There is a monthly payment,  a deductible until total prescription costs reach $150, then an initial coverage period.  Seniors pay less for preferred generic drugs, say $5 ; more for non-preferred generics, $35;  and way more for Brand name drugs 34%.

When the amount you and your plan have paid reaches $2,830 you reach the “donut hole” — the gap between $2,830 and $4,550 — you pay all the costs.  The point of this was to provide a powerful incentive for patients to ask for generics, and use a generic when their doctors agree.  If the patient cannot afford to pay the $1720, there is a program to pay for that. Once the patient reaches the $4550 threshold, there is only a small co-payment, and Medicare pays the rest.  It is essentially catastrophic care.

As far as I can tell, there have been no studies to determine to what extent the drug benefit has reduced Medicare costs.  Many newer drugs prevent more serious complications, including major surgery.  I don’t know if the cost-benefit could be determined, but if seniors take the drugs that are prescribed, lives are prolonged.

What Democrats have done is insert a little benefit that may not be needed, and decreased the incentive that lowers everyone’s cost.  What is interesting is that seems to be the only thing the Democrats have to brag about in a commercial directed at Seniors. Dr. Berwick bragged on it in his Congressional appearance.

So the Senate Finance Committee had Dr. Donald Berwick in to chat.  Dr. Berwick was sneaked into an office overseeing the world’s second largest health insurance company — the Center for Medicare and Medicaid Services (CMS) — with a “recess appointment” which avoided a single hearing by Congress, in absolute defiance of Constitutional intent.

Senators got to meet him, but were allowed no time to question him.  The prepared transcript of his remarks portrayed a very different person from the Dr. Donald Berwick that we have met through his writings and through YouTube videos.  The transcript presented him as a strong patient advocate and champion of patient rights.  Go to YouTube and the internet for his speeches and statements, and you’ll see a different person.

Berwick is known for his extraordinary admiration for Britain’s failing National Health Service.  In his book New Rules he writes” “Today this isolated relationship (between doctor and patient) is no longer tenable or possible.  Traditional medical ethics, based on the doctor–patient dyad must be reformulated to fit the new mold of the delivery of health care…Regulation must evolve.”

Berwick hates the American system of health care, believes firmly in rationing (and that he is just the person to do it), and believes that health care should be a system for wealth redistribution.  He has always regarded himself as a “leader” who needs to radically change American HealthCare and particularly qualified to do it.

Do follow the link to read the full opinion of Dr. Hal Scherz, a pediatric urological surgeon at Georgia Urology and Children’s Healthcare of Atlanta, serves on the faculty of Emory University Medical School and is president and co-founder of Docs4Patient Care.