Medicare Part D: You get what you vote for

Want to know how George W. Bush’s Medicare Part D program is working? Read this, from Newsday:

... 95 percent of Medicare beneficiaries who need coverage have yet to decide whether and how to enroll. During the first 11 months after passage of original Medicare in 1965, 93 percent of those eligible had enrolled.

No one knows yet how many of the 6.4 million "dual eligibles," poor or disabled Medicaid beneficiaries also eligible for Medicare, were automatically switched from Medicaid to Part D on New Year's Day, as the law required, without missing their vital medicines. My guess is that thousands of the sickest and most vulnerable people were not successfully switched and will be desperate for their medications. But CMS, at the Department of Health and Human Services, has not figured out what to do to tide over such people. After the dual eligibles are switched, they can choose their own drug coverage. Although Part D is supposed to be voluntary, if a dual eligible does not enroll in Part D, he or she would lose Medicaid coverage for other health services.

If you have health insurance from a former employer and you signed up for Part D drug coverage, be careful; you and your dependents could lose all your health coverage. Companies and unions that took subsidies to continue retiree coverage will not receive the subsidies for retirees who join Part D. Therefore, they will end all retiree health benefits for beneficiaries and their covered spouses and dependents if the retiree signs up for Part D - and they might not tell you. So check with your former employer and, if necessary, disenroll from Part D.

To make matters worse, a dual eligible's family could lose all their retiree coverage without knowing it if he or she is automatically signed up for Part D. Many of those beneficiaries are in nursing homes. Again, if your family is getting retiree health coverage, check with your former employer and, if necessary, quit Part D.

Meanwhile, in California...

Even as the state spends millions of dollars on emergency prescription drug coverage for more than 200,000 elderly, poor and disabled Californians, many of their claims are still being denied, healthcare groups said Tuesday.

Patients' advocates and others said they continue to get reports from throughout the state that many enrollees in the federal prescription drug program are being told that their medicines are not covered, or are being charged hundreds of dollars instead of the $1 to $5 co-pay they actually owe.

This is health care George W. Bush’s way. (Keep that in mind when he proposes -- one more time -- his miserable privatized healthcare Health Savings Accounts in this year’s State of the Union address. And recall: if it were up to him, by now Social Security would be well along the way down a comparably horrid path.)

As usual, they can’t say they weren’t warned about the impending Medicare Part D disaster by someone objective and independent (though, doubtless, they will...)

...a Government Accounting Office report, issued in December, [warned] that the Bush administration hadn't done enough to make sure the most medically and financially vulnerable Medicare beneficiaries could actually get their drugs.

If you do get around to reading it, make sure to check out the part where Mark McClellan, director of the Center for Medicare and Medicaid Services, says the GAO has it all wrong--the part where he insists that "CMS has established effective contingency plans to ensure that dual-eligible beneficiaries will be able to obtain comprehensive coverage and obtain necessary drugs beginning January 1, 2006...”

Or, perhaps they will say that any huge government program will have, well, a few glitches (ignoring the fact that the original Medicare program, far bigger, launched with hardly a hiccup back in 1965. Why? Because the Johnson administration put people in charge who were actually committed to making government work...

Today, the man directly responsible for Medicare is Mark McClellan, a physician and former Stanford economist. Though hardly a Michael Brown, McClellan has no prior experience when it comes to implementing social insurance programs. (His predecessor, Tom Scully, left CMS to become a lobbyist almost immediately after the Medicare bill passed.) The man Johnson tapped to run Medicare was Robert Ball, a longtime civil servant who had worked his way up through the Social Security Administration starting in 1939. He and other veterans helped design the program--urging, among other things, that the law take effect in summer, when hospitals would be least crowded.

Another difference between the two administrations is their willingness to take initiative. Last year, experts repeatedly warned the Bush administration that it had inadequate contingency plans in place, culminating in a December Government Accountability Office report that predicted with eerie accuracy exactly what has happened at pharmacies around the country these past two weeks. LBJ's team was far more cautious. Although confident that hospitals could handle any potential surges, it still drew up plans for transferring patients to overflow facilities, even lining up helicopters in Texas to provide speedy transport.

But then, it never really was about honest and competent government, was it? Because if it were,

...Bush’s people wouldn’t have hidden the program’s actual cost, to the point of threatening Medicare’s chief actuary with being fired if he told Congress the truth...

...nor would the Republican leaders of Congress have illegally attempted to bribe members of Congress to vote for their misbegotten plan...

If they ever do get this thing working the way it’s supposed to, millions of Americans will find themselves without benefits right in the middle of the year, thanks to the plan’s built-in $2,850 “donut hole”...

While the pharmaceutical industry keep pocketing billions of dollars in windfall profits all year long...

No, from the very first, it never was about actually governing (that’s hard work):

“There is no precedent in any modern White House for what is going on in this one: a complete lack of a policy apparatus," says [former Bush aide] DiIulio. "What you’ve got is everything—and I mean everything—being run by the political arm. It’s the reign of the Mayberry Machiavellis."

In a seven-page letter sent a few weeks after our first conversation, DiIulio, who still considers himself a passionate supporter of the president, offers a detailed account and critique of the time he spent in the Bush White House.

"I heard many, many staff discussions but not three meaningful, substantive policy discussions," he writes. "There were no actual policy white papers on domestic issues. There were, truth be told, only a couple of people in the West Wing who worried at all about policy substance and analysis, and they were even more overworked than the stereotypical nonstop, twenty-hour-a-day White House staff.

Every modern presidency moves on the fly, but on social policy and related issues, the lack of even basic policy knowledge, and the only casual interest in knowing more, was somewhat breathtaking: discussions by fairly senior people who meant Medicaid but were talking Medicare; near-instant shifts from discussing any actual policy pros and cons to discussing political communications, media strategy, et cetera. Even quite junior staff would sometimes hear quite senior staff pooh-pooh any need to dig deeper for pertinent information on a given issue."

From Iraq to Hurricane Katrina to Medicare Part D, George W. Bush is nothing if not consistent. You get what you vote for.