> HOWEVER, the bill creates $12 billion in subsidies to private companies to
enable them to do Medicare >business. SO we get all the inefficiencies of
private profit seeking AND we get to pay public money. This is >what most
Democrats/commentators were refering to in their attacks on "privatization"
presumably.
Ooh, ooh-- cut "subsidies to HMOs" to fund more benefits for seniors. New plank for Dems :)
>Nathan got the cost control mechanisms built into the legislation wrong as
well (in fact, understanding the >mechanisms may strengthen his point).
Future prescription prices get built into the premiums and deductibles >born
by recipients. This is one of the really horrible things about it. Now,
this will undoubtedly help create >political pressure to reform the package
but sadly does not necessitate Congress or anyone else "to do things >about
drug costs."
I understand how future increases get passed onto seniors, but there is still pressure to cut on the amounts that government will pay starting in 2006 itself. This is why big Pharma has feared the bill from the beginning; they like the cash coming there way, but it could easily come at a price if government gets involved-- as they have in every other country where government pays the cost of prescription drugs. It's will just be too big a bullseye in the budget to ignore.
>I also need to correct a few other policy matters:
>--The bill does other things to Medicare benefits that are not so good:
like creating
>higher premiums for Medicare Part B (while this is a "sliding scale" I
generally think
>it is wrong to means test programs)
Agreed.
>--Medicare does not cover "every other kind of health care" as Nathan
suggests, in fact
>it leaves out any long term care coverage which is pretty damn important if
you consider
>it covers 65+ and disabled.
True-- a bit of hyperbole on my part.
>--MEDICAID already covers senior prescription drugs for the poor and
>large private employers cover it for their retirees.
Although the shift of some of the costs of prescription drugs from Medicaid to the new Medicare prescription drug program may be one of the most progressive results of the bill. The estimate is that this will leave an additional $30 billion in Medicaid available for other purposes over the next decade-- and probably add up to even more additional funds just by relieving the program of the likely escalating costs of prescription drugs over time.
I think it's been a problem that poor elderly care has been pitted increasingly against the major source of health care funds for the non-elderly.
>--The new co-pays that even the poorest have to pay have seriously bad
implications for the most >economically vulnerable. I would not gloss over
this either.
I agree, but I still think the additional $400 billion gives progressives a lot more room to maneuver to improve things, then having no bill at all.
>I do think it is sad that so much of the political leadership in both
parties, the media,
>and Nathan are more concerned with the myriad political implications of
this
>bill's passage than the actual implications to the well-being of Medicare
recipients.
>Very telling but still "sick".
Jim-- unfair shot. I specifically said I thought the bill will lead to better results on policy overall. You can cite the areas where it won't, but $400 billion in additional spending is not chicken feed and will improve the lives of a lot of folks who were too wealthy to get Medicaid, but too poor to afford medicine as things stand.
-- nathan
-----Original Message----- From: Nathan Newman [mailto:nathanne at nathannewman.org]
On policy, we now have the principle that drugs should be covered just like every other kind of health care under Medicare. Now, the question is how generous the benefit should be, which is a winning terrain for progressives. It's a lot easier to expand coverage in an existing program than create a whole new entitlement-- a fact that conservatives generally recognize and which is making most of the rightwing apoplectic as they see Bush and the GOP push through this plan for short-term political gain. As for the "privatization" aspects, I just don't think a few pilot projects and such are as threatening as most critics make out. And the very cost of the drugs will put pressure on Congress to actually pass drug cost controls as a deficit fighting measure.
Emphasize the last point-- without the drug bill, cost controls on drug manufacturers was just "anti-business regulation." With $400 billion in government spending at stake, suddenly drug price controls is a way to cut government spending, another good terrain for progressives to advocate against drug company profits.
As for the politics, passing a shitty bill is worse for the GOP than if the Dems had defeated it. If the Dems had defeated it, Bush could have said, "Well, I tried to fulfill my promise to give seniors a drug benefit, but the obstructions Dems stopped me." Now, Bush has full responsibility for the details of the bill and seniors won't be happy. They'll recognize that the trillions of dollars in tax cuts meant they only had this pathetic benefit available.
So much for the juggernaut.
Nathan Newman
----- Original Message ----- From: "Michael Pollak" <mpollak at panix.com> On Tue, 25 Nov 2003 mike larkin wrote:
>
http://www.nytimes.com/2003/11/25/politics/25CND-MEDI.html?hp=&pagewanted=print&position
[An article about passage of the medicare bill]
The LA Times cites a new, non-partisan poll which says respondents 65 and older oppose the bill by 49 percent to 33 percent. And that's before they figure out that nothing's covered in 2004.