Colorado Care May Soon Rise On Its 2016 "Ashes"

Comparison of Colorado Care provisions with those of the failed plan in Vermont. This post deals with a number of reasons why the former "went down in flames".

My wife, Janice - with dozens of others - had worked ferociously to get the Colorado Care health plan passed in the state in the 2016 election cycle. Alas, there was simply too much opposition arrayed against, especially the sheer volume of "free speech"...errr,  the money.  The Colorado Care team and activists had amassed some  $800,000 to support their campaign but were confronting the Koch brothers' deep pockets which easily had ten times more to spend.  No surprise the Kochs' ads- seen much more frequently (and laden with propaganda) won out.

But according to T.R. Reid - one of he spokespersons and lead voices for the bill, there is no reason that it can't come back on the ballot in 2020, provided some tweaks are made.


T.R. Reid - a long time advocate for a universal health care bill believes Colorado Care can be resurrected with the right tweaks.

In a recent interview with The Colorado Springs Independent, Reid made it clear what went wrong and now the next iteration of the bill could be improved. This is essential also in a hostile environment to any kind of social safety nets and with the Republicans on the warpath to tear down Obamacare by detaching its mandate. This despite a remarkable 55 percent approval rating in an April Gallup poll, and currently with a historically impressive 50 percent approval rating according to Gallup.

What happened? Millions of people - including Trump voters- realized they could finally obtain the affordable care they need, even with preexisting conditions. 

This elicits the question of why Americans have been chronically leery of enabling or allowing the government to run a health care system?  In fact, the reasoning is inchoate and absurd. As Reid put it in his interview:

"If government doesn't get between you and your doctor, then United Health Care in Minnetonka, Minnesota, gets between you and your doctor and dictates which doctor you can see, Public health payment plans are just more efficient and work better."

Adding:

"Just about everybody on it will tell you Medicare is the best insurance they ever had,  You know, I worked for the Washington Post company, and it's a very generous company, very generous, and it took really good care of us in terms of health insurance and Medicare's better than the insurance I had with the Washington Post."

I can vouch for that, completely. As I already noted in a post last month,  the CMS Summary sheets for the procedures carried out this past year totaled more than $60,000. This was for the 3D staging biopsy and cryotherapy cancer treatment at UCHealth.  The ultrasound guidance part of the cryo treatment alone came in at $16,000 and the anesthesia just for that treatment, not including the 3D biopsy anesthesia, was $3,149..

If I'd  had to operate under a $20,000 per annum GOP voucher plan, I'd have ended up shelling out nearly $40,000 out of pocket for the uncovered procedures.  None of that even would even had included the cost for wife's hip replacement surgery, including 7 days in rehab.

So, as T.R. pointed out in his Indy interview it is "silly" for people to bitch about government health care when one of the most successful ever designed has prevented more seniors from impoverishment than in the nasty early days.  That was pre-1966 when oldsters had to either hope a son or daughter would take care of them, or they had to beg on the streets for help.

But, of course, viewed as (GASP!) "socialized medicine"  that's why the Repukes are determined to destroy it now - when their tax plan comes a cropper with exploding deficits, as it surely will.

So what went wrong with Colorado Care, apart from the fact supporters lost the money as speech game to the Kochs?  T.R. Reid provided several plausible reasons:

-  People were quite willing to help a sick kid or neighbor, so hypothetically backed the plan However, the rubber hit the road when they read the fine print and grasped they'd have to help pay for it

- Seniors especially were against it as even though they'd have to pay there was no benefit at all for them. So why support it when they already had Medicare?

Janice and I discussed this very issue last year when we both attended a meeting downtown and after a presentation, one older lady on Medicare Advantage insisted there was no reason at all for her to vote for such a bill Not one which dinged her while providing  no further benefit.

But as we noted, it was precisely this "what's in it for me" mindset that's preventing the country from moving forward on a universal health plan.  By contrast, Europeans  - like our Czech friends Martin and Gabby, e.g.

are quite happy to pay higher taxes because they understand "we are all in this together".  As Gabriella told us while we dined out in Prague in 2015,: "You can't take the money with you, so why not spend it on better health for you and your fellow citizens. It is win-win."  This sensible philosophy also carried over into their daily lives, in which they valued time much more than extra money to work more hours. 

As Gabby put it: "Here in Europe the companies cannot work us to death or to the point of insanity like they do people in your country. That's why we can travel our continent for weeks at a time. Your countrymen would probably feel they have to check their cell phones or emails every day or twice or more a day!"

Back to the reasons for Colorado Care's downfall, T.R. also pointed to the wording on the ballot. The resolution began as follows: "Shall we raise taxes $25 billion in order to ..."   In he words of Reid:

"A lot of people thought we lost the minute that became the language of the ballot. You know, people were just not going to spend $25 billion. And the answer to that was, well we're spending over $30 billion on health insurance now to out-of-state insurance companies. But we never had the money to make that point."

Which is why a much more extensive grassroots education effort is needed.

What about future strategies for  resurrection? Reid's ideas are as follows, in his own words:

"I think there are two possible routes. One is put in legislation to the [state] Legislature to try to advance the cause. And, in that regard, we have written what's called the Colorado Patient's Bill of Rights. I think it's nine proposed bills. And they are bills like the Choose Your Doctor Act, and that says any health care plan sold in Colorado has to let the patient choose the doctor. As you know, currently, insurance companies have these narrow networks where they dictate the hospital and the doctor you can go to. So we're going to put in legislation that says they all have to do what Medicare does, which is cover all doctors, any licensed practitioner. That's one bill. Another is the Why Pay More Act, and that says whenever a hospital or a doctor bills you for a procedure, the bill has to show you what Medicare would have paid for the same procedure. And presumably then people will respond and say, "Why am I paying $36,000 for a hip [replacement] when Medicare pays $1,900 for the same procedure?"

... Different legislators have offered to put in those bills, and here's the thing: They're all gonna lose. Because the hospitals or the doctors will fight them and they'll lose. But that kind of makes our point, that the Legislature is not the place to get this done because it's owned by insurance companies and for-profit hospital companies and drug companies.

... The second plan is to come back on the ballot in 2020. And if we did that there's two crucial points about that idea [usually called the 2020 plan]. One is that the plan would be vastly simpler. Our last plan was quite complicated, we had a 35-page booklet explaining it, you know just about everybody could find something in it they didn't like, so I think next time we will make it much, much simpler. Maybe, for example, one proposal is for a two-sentence ballot initiative. First sentence is: Anyone who needs medical care in Colorado shall have access to a doctor. And the second one is: The Legislature is mandated to effectuate this guarantee by Jan. 1 of, you know, whenever."

The Indy: Where would the funding come from in this scenario?

T.R. again:

'That would be up to the Legislature, but presumably, it would come from a tax just like ours.But if the people vote for this concept, then everybody should have health insurance. The Legislature has to enact it. I mean, it doesn't solve all the problems — then the Legislature has to go back to the voters and say, "Will you pay for this?" But at least then we have the opportunity to say um, a) the people want this, they voted for it, and b) it's cheaper ..."

Indy: What year?

"In 2020, and the plan is, 10 states put the same measure on the ballot in the same year, and they would be Oregon, Washington, Colorado, New York wants to do it, Ohio and Michigan have talked about it, maybe California. And the theory is then, if it's on in 10 states, this will dissipate the insurance companies' money. You know, they'll fight it in New York and California at great expense, and maybe that would let Colorado or Oregon or Washington slip past, because they wouldn't be able to fight it everywhere ... Almost every state has a group of people who are working for universal health care ... and they've decided the way we're going to get there is state by state. Washington, D.C., can't do it."

One point of Reid's needs to be underscored: Don't look to the gridlocked Beltway for any help on affordable health care. It may well be up to state versions of universal or single payer health care to win the day. Provided the respective citizens agree with Gabby's take that "we're all in this together" as opposed to the individualist path of "every one for him or herself".

Why We Can't Afford "Medicare for All" - Megan McCardle Thinks She Has The Answers

One of the hyper-expensive medical "toys" driving up health care costs - the 3T MRI machine. The costs of such machines, including proton beam therapy and cancer drugs are making access to medical care more and more prohibitive.

In his extensive Barbados Advocate column (April 30, p. 14, 'Addressing the loss of health care professionals') David Jessop shed light on exactly why medical costs are soaring in all the nations of the world. As he wrote:

"Around the world, public health care systems are in crisis. From India to Australia, nations in the developing and developed world are struggling to meet the expectations of their local populations."

What reasons does he give for this crisis? He lists the following as primary culprits:

- A surge in the nature and volume of demand as populations age and birth rates continue to increase

-  The preceding occurring at the same time a desire for low taxes has made it difficult for governments to garner the necessary resources to respond to societal expectations

- Sustained loss of medical professionals causing shortages in many 3rd world nations, because they are picked off by nations such as the U.S.  - which itself is finding it can't cope with the expansion of medical services (e.g. via Medicaid in the ACA) combined with an M.D. shortage.

This combination in addition to overuse of medical resources by certain groups, has led to the condition in which much of the world is in a health care crisis.

The bottom line is this: It is futile to talk about "managing" health care costs when so little money is made available by many nations to support their current medical needs. In effect, medical care today  - from treating cancers to severe disability and chronic disease (e.g. kidney and liver disease) is bloody costly and intensive of medical resources by nature.

This leads to a Hobson's choice for many governments: either raise taxes to support their local populations' access to medical care to the level needed, or cut access as the Republicans are now doing with their "American Health Care Act" that will effectively remove access for 20 million or more via Medicaid.

Aging populations in whatever country definitely carry major impacts on its health costs. According to a paper ( Death and Taxes: Why Longer Lives Cost  Money)  produced by the UK Institute of Economic Affairs:

"Long-term healthcare and nursing home costs are strongly associated with age and cannot be driven down by healthier lifestyles.."

To be specific, the incidence of both certain cancers (e.g. prostate) and Alzheimer's disease are  directly related to age, not necessarily "unhealthy" lifestyles. The risk of Alzheimer's alone doubles every year after the age of 65, no matter who you are, what your gender or income or life style choices. Ditto with prostate cancer which is becoming more and more expensive to treat as new, more refined treatment techniques come onstream, - such as focal therapies (e.g. focal cryotherapy) and proton beam therapy,

In the case of prostate cancer, which I've been battling for five years now, I've seen at every stage the cycle of treatments and tests and how they multiply costs. Even if you'd prefer to not add to the medical loss ratio (the ratio of unhealthy subscribers to the healthy ones that support them.) it's virtually impossible once you get that PSA test result - if much higher than normal - to avoid the first prostate biopsy.  That biopsy, if it shows one or more cores at the Gleason 7 score level or higher, sends you down the path of more tests, therapies, treatments. Unless you don't give a shit, in which case your primary doc may "fire" you for being a "non-compliant patient". She wants you to continue your life under her care (including specialist referrals)  without facing the worst consequences of a cancer that can kill (29,000 deaths in the U.S. each year).

In my case, the first biopsy proved positive with three cores then affected and I had to make the decision to get either the robotic (Da Vinci) surgery or radiation. I chose the latter, for which I received high dose brachytherapy treatment at UCSF and paid my bit at about $1,200 - because by then I had Medicare.  The total price for all aspects of the treatment, including  CT scan, spinal epidural, Ir 192 needles insertion,  and follow-up came to just over $55,000.

I thought that was the end of it but the cancer remained and PSA tests showed the need for more biopsies as well as MRI scans, and even a 3D staging biopsy which finally showed the cancer at least concentrated at one location in the interior, e.g.

Total costs by now totaled over $85,000 including all the various tests such as CT scans, MRI scans, MRI fusion biopsy, Prolaris genetic test, and so on. 

SO given this it is easy for Bloomberg writer Megan McCardle to blab in her recent column about "adverse selection" say if Medicare was ever to expand into "Medicare for all".  McCardle's point is that such a program would ensure ever higher premiums year by year since the sickest people - or those who need expensive treatments and tests -  are the most likely to make use of it. Hence one gets what the insurance bunch calls "adverse selection"  Technically, the term is defined by insurance wonks as:

Adverse selection is a concept in economics, insurance, and risk management, which describes a situation where market participation is affected by asymmetric information. When buyers and sellers have different information, it is known as a state of asymmetric information

But I argue, as does David Jessop, that this kind of economic concept has no place in health care delivery because people are not cars, homes, or fancy jewels. Look, if populations are continually growing that logically  means sick conditions and diseases must grow with them-  whether cancers, Alzheimer's, kidney disease or whatever. Even the healthiest person following a rigorous diet  can get cancer or be injured in an auto accident. Hence, the notion of "asymmetric insurance" for a risk pool managed by a health insurer is ludicrous. There can be no such thing because one will know from the get go that every manner of sickness and disability can only expand, especially for older age groups.

The subtext for McCardle's arguments is the medical loss ratio suffered by putative health insurers, including exchanges -is too great. Hence, so many now abandoning the ACA as too "expensive" to support- so why even consider 'Medicare for all'?  In this regard, if the number  of sick patients in any risk pool is 'significant' - say more than about 1 in every 20-  the private insurers' profits take a nosedive. The medical loss ratio has increased beyond acceptable levels, so the shareholders will not like it.  This is precisely why health insurers - with the exception of Medicare - have become ,more leery of accepting too many oldsters or chronically sick patients. It means major loss of profits. Thus, the imperative becomes one to deny needed care rather than to provide it, especially for pre-existing conditions.

Some on the Right are so desperate to justify cuts to Medicare - as well as Medicaid -  that they argue (as one letter writer did in a recent WSJ contribution) that  pre-existing conditions must be factored in for insurance rates because if they are not known then it is a case of "asymmetric information", i.e. the patient knows he already has some type of cancer but not the insurance company or health exchange with which s/he seeks coverage. Hence, the demand to report all pre-existing conditions before being insured, the better to fix deductible and premiums ab initio - if at all.

To which I and Jessop respond: As a health insurer you're supposed to be in the business of helping people get appropriate treatments for their illnesses, not deny them.  Are you going to deny them the care and make them severely ill, or  go bankrupt, to appease insurance wonks? Or Republican tax cut fetishists?

But McCardle has even bigger budget "fish" to fry than adverse selection might interject. She writes:

"A far bigger problem is what this might do to hospital budgets. Why? Because Medicare doesn't  necessarily pay enough to keep those hospitals running."

She is correct that Medicare controls some of its costs by shifting them to private insurers (she calls it "off loading") which is why Medicare supplemental (e.g. Plan F) insurance exists to make up the difference, As she points out:

"The hospital's fixed costs are mostly getting covered by higher reimbursements from private payers."

Allowing this isn't "necessarily cheating". Well, that's very generous of her!  But her underlying theme is that in a Medicare for all scenario all who buy in would also have to get private insurance from someplace because the single payer (government) simply wouldn't be able to handle all the costs.

There are two aspects she overlooks that could lower costs for all, and make a Medicare for all system more palatable.

First, a large part of increased Medicare costs is due to a program called "Medicare Advantage" (MA) which was created by BushCO and the Republicans with their Medicare Modernization Act of 2003. It basically confected a privatized form of Medicare ("Part C"), with the express purpose of bleeding regular (traditional) Medicare into insolvency by blowing up to $20-25 billion or more a year (based on gamed "risk scores")  and funneling much of it from the older program. Unless this (MA) program is killed (the sooner the better),  no other cuts will matter - because MA will metastasize to the point every $ is swallowed up.. For those who wish to read the details on why MA is hurling Medicare into insolvency check out the content in these links:

https://www.publicintegrity.org/2014/06/04/14840/why-medicare-advantage-costs-taxpayers-billions-more-it-should

 And:  https://www.medicareresources.org/blog/2015/11/04/is-medicare-on-the-brink-of-insolvency/

Second,  Medicare monies are being bled down by drug costs to the tune of $250 b over ten years, because it isn't allowed to bargain for the best prices like the VA.

Even so, fixing the above distortions Medicare will simply be brought more into a financial equilibrium i.e. to avoid insolvency. It would not really enable a dramatic expansion to "Medicare for all".  For that to occur, wait for it, taxes would have to be increased and significantly as in western European nations such as Germany, France.

As Jessop concedes the choice is one between more taxes or less health care.  So if citizens think higher  taxes (by 25 % even for "middle classes")  are the worst thing in their lives, what could happen? Well,  what if they are laid up in a hospital bed with severe disability, pneumonia  or leukemia? Is going bankrupt more to their liking?  Again, for most Americans - who are tax hating Pollyannas-  they are convinced they're never going to get to that extreme fate so they make the bet those dire medical disasters won't happen to them.  But it's a terrible bet because they can happen to any of us! (As I found out when I learned I had prostate cancer that had to be treated.)

Make no mistake that 'Medicare for all'  would be the for profit medical  industry's biggest nightmare because they'd no longer be able to reap profits by invoking medical loss ratios - preventing sick people from getting care instead of delivering it. Hence, they and their  political lackeys and extremists will be prepared to fight like junkyard dogs to prevent it, including the perverse use of propaganda.

McCardle's final cautionary argument against a single payer system is that it would lead to drastic cost cutting, i.e."hospitals would probably have to resort to draconian measures  which might result in patient lives lost".   Perhaps. But the way to avoid such drastic cost cutting is to ensure enough taxes are available to pay for the care needed by the sick segment of a populace. After all, if everyone was a picture of health and had the genes never to fall ill, health insurance would barely be needed - unless a person crossed a road recklessly.

McCardle writes at the end of her piece:

"I'd want to be  a lot surer before I started running a mass experiment for our nation's physical and fiscal health"

But then she can afford to exercise patience, being a highly paid Bloomberg scribe. Many citizens, especially in Trump country - and now facing (in 18 OH counties, after the retreat of Anthem) no more naxalone for opioid overdoses cannot.  It's a matter of priority for getting scarce medical resources and paying for them!

In this regard, the citizen needs to inform himself as much as possible about what the real arguments are for and against 'Medicare for all'. And also ask himself if he is willing to pay significantly more in taxes to be assured of better access to health care.

Perhaps the issue is best summarized by WSJ letter writer Clay Creasey (June 6, p. A16):

"It is time for intelligent conservatives to realize that the vested interests of our current health care system (insurers, drug companies and lawyers) are selling us down the river. They claim single payer is socialism. In fact, it could be the single biggest contributor to economic growth  "

See also:

http://smirkingchimp.com/thread/william-rivers-pitt/73390/we-are-not-broke-trashing-the-austerity-lies

Spending Too Much On The Elderly? Absolutely Not!

Affirmation: Medicare and Social Security are the bedrock programs of American liberalism.

Question:

 "Then why do so many liberals consider it taboo to even suggest adjusting these systems to ensure their sustainability for future generations?"

Response: Liberals emphatically do not regard it as "taboo" to "adjust" these systems so long as that does not mean outright cuts - which serve no one's purpose. In addition, adjustments have already been implemented including ACA future budgetary fixes to "means test" more middle class seniors in Medicare as well as moving greater medical burdens to individuals, including: higher medical co-pays, higher premiums, etc.

This response is needed given 'We The People Live'  host Josh Zepps' claim of  "progressive orthodoxy" (e.g. to fix Medicare especially)  in an original Salon.com video filmed at the Democratic National Convention. (You can google Josh Zepps video at DNC to pick it up)

Zepps claims that America’s resource allocation is "in need of a serious reexamination"  This is also a theme that's been recycled in a number of media outlets including The Wall Street Journal, The Financial Times and New York Times.  The core argument or thread running through all is: Young workers, families are getting the shaft as more and more resources, funds are funneled to the elderly in social programs.

What is Zepps further justification? He argues:

“Medicare costs more than $500 billion per annum, 30 percent of which is spent on the five percent of beneficiaries who die each year. One third of that is spent on the final month of life. The final month. I mean, you want to talk about priorities, let’s just take that one datum. More than $50 million each year spent on the final month of life.”

Let's examine this at some length. First, Medicare costs are exploding, but a large part of that is due to a program called "Medicare Advantage" (MA) which was created by BushCO and the Republicans with their Medicare Modernization Act of 2003. It basically confected a privatized form of Medicare ("Part C"), with the express purpose of bleeding regular (traditional) Medicare into insolvency by blowing up to $20-25 billion or more a year (based on gamed "risk scores")  and funneling much of it from the older program. Unless this (MA) program is killed (the sooner the better),  no other cuts will matter - because MA will metastasize to the point every $ is swallowed up.. For those who wish to read the details on why MA is hurling Medicare into insolvency check out the content in these links:

https://www.publicintegrity.org/2014/06/04/14840/why-medicare-advantage-costs-taxpayers-billions-more-it-should

And:  https://www.medicareresources.org/blog/2015/11/04/is-medicare-on-the-brink-of-insolvency/

Zepps is correct about the magnitude of Medicare spending in the final months of life. But I believe that is the fault of the medical establishment and its specialist practitioners. This is based on not leveling with severely infirm elderly people regarding limits of additional treatments and their real costs v. benefits.. Missing in most treatment discussions, for example, is any reference to quality of life . The focus is exclusively on quantity and that also often comes with huge medical costs. Missing "the talk" is it any wonder older patients tend to believe medical treatments can offer curative solutions rather than only palliative ones?

In my own case I already mentioned my prostate cancer which has now recurred. I also discussed some of the many treatment options, e.g .

http://brane-space.blogspot.com/2016/07/no-you-dont-have-to-accept-further.html

and:

http://brane-space.blogspot.com/2016/07/why-do-so-many-men-opt-for-castration.html

I have been immersed in research on treatment options and what I have found thus far isn't encouraging, including:

1) Cancer experts themselves can't agree on which primary treatment is best.

2) The same experts (oncologists) can't agree on which ("salvage") treatment for recurrent disease is best, or when to start it.

3) Most agree that if a guy has recurrent disease and a biopsy shows it has spread to the bones ("bone mets"), his days are basically numbered - though certain treatments (e.g. hormone) will allow some limited life extension.

The question then becomes: How much life extension? While I don't want to croak prematurely and deprive my many readers of my blog posts and insights, I also recognize that once I hit a certain phase in possible further treatment (called "castration resistance") it is basically time to pack it in. Game over. Finito. Some will yelp: "You can't give up or quit!" but the flip side of that is Zepps' point that we spend excessively to stay alive in the last months when all the pointers show we ought to be going to hospice care and telling the medical industrial complex 'Enough!'

The problem is that the medical complex doesn't want to quit since they see it as a renunciation of their practice to fight for life all costs.  Hence, they regard the palliative option as failure, even though added treatments may only marginally increase life - but usually at the expense of life quality. (E.g. hormone treatments for advanced prostate cancer can increase life by 1-3 years but usually with side effects including: memory loss, depression, diabetes, cardiovascular problems, enlarged and tender breasts, shrunken testicles, zero libido and hot flashes such as suffered by menopausal females.).

So in this I do side with Zepps. The tricky question for him (and other would be "adjusters")  is: WHO assumes responsibility for telling an older patient his or her days are numbered and they need to just go gently into that good night? Medicare now has a special program where end of life issues are addressed, but as yet too few patients are getting these consultations, often because their nervous PCPs don't refer them.

I encountered this when I told my own PCP back in June - after the latest PSA test came back at 6.0 - that I planned to do nothing more. I wanted no urologist referrals, no more biopsies, no more anything.  Her reaction? She wouldn't hear of it. Short of strapping me down to the exam table and coercing me, she said I HAD to see the urologist and listen to what he said concerning the latest MRI results  So, while my inclination was to halt all further medical involvement, she wasn't going to play along.  In effect, she intended to add more medical intervention and expenses to my Medicare account. .(Mind you, her adamant stance could well be traced to our litigious culture, especially relative to  medical practitioners, whom we often hold to absurd standards of action and  judgment.)

Same thing with an oncology RN at UCSF who phoned me up after the MRI and stated I "sounded too young" not to accept brachytherapy salvage therapy, i.e. instead of possibly dying at 74 or 75.  When I asked about the side effects she kind of dodged the extreme "level III toxic comorbidities" which included loss of bowel and urinary control and extreme pain with every excretion - thanks to the radiation (36 Gy delivered in two fractional treatments a week apart - under general anesthesia)

How does Zepps propose we deal with  such situations? Clearly, his superficial call for simple "adjustments" shows he doesn't want to get "in the weeds".  But at the same time, you can't just uniformly cut $50b from Medicare and tell sick oldsters to "sink or swim".  And as I noted, Medicare already has the end of life palliative care option in the program (as part of the ACA), ostensibly to limit end of life expenses. But how does it get maximized without resorting to draconian cuts? The devil, as always, is in the details.

Zepps adds:

"The left needs to reckon with the uncomfortable truth that what this country is doing is sapping the vitality of the young and pumping it into the elderly,” he says. “It is a gigantic resources Hoover from young professionals into old retirees.”

But as I pointed out the ball is not in the "Left's" court, it is really in the province and court of the medical establishment.  It is also in the court of the craven politicians who are not prepared to tell Medicare Advantage folks that they need to come out of that too expensive program and go into regular Medicare. Their MA is costing taxpayers way too much each year.

First, if Medicare Advantage had been mothballed, as Obama originally vowed to do back in 2011-12,  we would already have seen more than $75 b saved over the past 4 years. Second, if that Part D Medicare drug plan had been altered to allow bargaining for lowest cost prescription meds like the VA, another $200b would have been saved. (Especially in the wake of the news that costs for catastrophic disease drug prescriptions (like for Hepatitis C) have gone up 85% since 2013.

Third, if the medical establishment more faithfully implemented end of life palliative care conversations with patients - via the Medicare program for that purpose - we'd save a lot of that $50b used in the last months of life. But this portends a massive change in perception by that same medical establishment, to wit, maybe they themselves need retraining especially in the nature of palliative care. This latter as opposed to pushing new and expensive treatments that only marginally improve life extension.

How then do we convince patients as well as the medical experts that end of life quality is as important as quantity?

When Zepps can answer these difficult questions, as opposed to merely interjecting "adjustments" (read cuts) for the sake of cuts, we would be more likely to take his arguments seriously.  It is evident to this observer that Zepps, like so many of his younger cohort, is too ready to blame oldsters for what are really faults of the health system we have. That includes the presence of insurance companies with their built in extortion and selective rules As I noted before, the only way out is a single payer system such as my wife and her activist group are fighting for here in Colorado with ColoradoCare and Amendment 69, see e.g.

http://brane-space.blogspot.com/2016/07/janice-gives-robust-defense-of-colorado.html

Sadly, Zepps objects to those who would "change the topic" by pointing to other items in the federal budget that could use cutting. But this is being myopic and foolish. Because unless we closely examine those other items, especially military spending for which the GDP allocation has doubled since 9/11, we will never get anywhere in terms of real world priorities.  See e.g.  http://brane-space.blogspot.com/2012/07/muricans-need-to-wake-up-about-military.html

Does the U.S. REALLY need 900 foreign military bases worldwide to fund to the tune of over $1 trillion a year? Especially as the Pentagon already "misplaced" $1.2 trillion in budget allocations prior to 9/11, according to former Defense Dept. analyst Chuck Spinney in a 2002 PBS NOW appearance . Does U.S. "defense" spending REALLY need to exceed that of the next 25 nations?  Clearly Zepps needs more education, though one must give him a prop or two for his audacious salon.com video. But to shed needed light (for his benefit) we can thank Nancy J. Altman and Eric Kingson, authors of 'Social Security Works' .

As the authors observe (p. 40):

"It is false that most older Americans are on "easy street". A very small percentage are, many more are poor or near poor, while some maintain a modest, middle class life style, often struggling to make ends meet."

So much for Zepps' indiscriminate claim of a "resource Hoover" hoovering up everything not bolted down for the benefit of fat, complacent seniors.  (Many of whom still have kids living in their homes, basements because they can't get decent jobs).

Last but not least, Zepps doesn't cover Medicare fraud at all, which could easily be neutralized by implementation of a computer system to track care received over time by different providers.  

I have shown in this post (including links) that Zepps' arguments are immature and don't take full account of: a) how seniors have been exploited by the existing system, and b) how younger workers and families are being exploited by a Neoliberal system with misplaced priorities.  One whose design and financial reward basis finds it more profitable for companies to fund massive stock buybacks than create jobs with decent salaries.

But one thing we cannot do is permit superficial memes and facile arguments against senior health and other benefits to be spread, thereby propelling a push for an elderly  "hunger games" . 

Btw, if the Reepos in the Nov. election seize  all branches of the government, Zepps may get his wish of massive cuts, thanks to Paul Ryan's Medicare voucher plan..  That will save hundreds of billions for sure, but leave most elderly in the same position they were in before Medicare arrived in 1966. That is, begging and scraping for financial help from family, offspring just to stay alive to deal with normal health issues - never mind treating stage IV prostate or breast cancers.

Doctors Are Correct to Wage War On Drug Prices

Under the header "It's About damned time",  is the outcry less than a month ago by more than one hundred oncologists from top cancer hospitals that the cost of cancer drugs is way too high. Indeed, the cost of many drugs is too high, and Americans are literally being taken to the cleaners by Big PhRMA.  So no surprise many doctors, not just oncologists (cancer specialists), are calling for new regulations to control the costs.

In fact, the oncologists and other doctors are only the latest to make vocal complaints. Preceding them have been insurers, state Medicaid officials, and most of all patients - many of whom have been forced to forego prescriptions because of the exorbitant costs.  All this in the wake of prescription drug prices rising more than 12 percent last year, and many prescriptions increasing more than 100 percent.

For example, as noted in an NBC News segment last night, one pharmacist complained that "it was the craziest price increase ever seen" in his life. He cited the wholesale price for the diabetes drug Glumetza which went from $1,000 for 90 days supply in January to just over $10,000 in July. He noted he had no choice but to pass the higher costs on.

The plight of patients was highlighted in one Mayo Clinic Proceedings editorial in which the financial burden was emphasized with the out of pocket costs bankrupting many just as they're fighting a deadly disease. As a result 10 to 20 percent of cancer patients don't fulfill their treatments as prescribed - and their cancers metastasize.  And 75% of other prescription drug takers have cut back on their medications, risking complications. No country with any dimension of decency can allow this to go on.

Fortunately some members of congress are on to this and have demanded that the pharmaceutical companies justify the pricing of hepatitis C medication which now runs tens of thousands of dollars per patient.  

Bernie Sanders, for example, has already advised the Department of Veterans Affairs to break the patents on hep C drugs so that generics companies can manufacture more of them for ailing vets. The problem is the Repukes won't hear of it as it constitutes "statist" interference in private business - so let the vets fend for themselves.

But this ought not be amazing or surprising given this is the typical Reptile response to everything concerning regular citizens - i.e. those not born with gilded spoons in their mouths.

Meanwhile, more sobering for many, has been the announcement from Medicare's Board of Trustees that expensive new medications will drive a sharp increase in the program's prescription drug spending over the next decade. In this milieu cancer medication increases have drawn particular ire with the average price of new cancer drugs having increased in the U.S. five fold to ten fold over 15 years to over $100,000 a year in 2015.

This isn't merely criminal, it's an abomination given those who can't afford the drugs are being issued a death  sentence. The newest and most effective drugs are those that harness the patient's own immune system and these can run up to $150,000 per patient per year. And the annual cost per patient could approach $300,000/ year if cancer drugs are prescribed in combination

As one Mayo Clinic hematologist put it:

"What we're fighting is the greed. The greed and the additional maneuvering that is being exercised after you've already recouped what you've invested. There is no control, no regulation."

This raises the plausible thesis that this "additional maneuvering" with no oversight - was actually built into the "Medicare Modernization Act" that Billy Tauzin and his Reepo criminal congress forced through back in 2003 - to the cheers of Big PhRMA.  It was no wonder that soon after it passed, Goldman Sachs estimated the benefit to PhRMA ( in terms of corporate welfare), would be over $13.7 b over ten years. It's probably even more now.

Indeed, another vile aspect of the 2003 law was that it barred Medicare from negotiating for lower drug prices like the VA does. The law actually leaves the negotiating to private insurance companies and pharmacy benefit managers. The very existence of this refuse denies Medicare the ability to drive down prices - and indeed control prices. But then many of us at the time suspected the maggot Bushies were behind this recklessly expensive, bogus law as a means to rush Medicare toward insolvency - the better to privatize it. They even embedded a Trojan horse in the law called "Medicare Advantage" which is now spending $12b a year more than traditional Medicare.

Of course, the usual excuse trotted out by PhRMA for its current skyrocketing drug prices is that it "costs so much for research" - which is arrant bull pockey. The truth is the drug companies are blowing most of their profits and returns on TV advertising. Just look at a typical prime time news broadcast on any of the networks, you are sure to see at least five drug ads including one for Cialis or Viagra, every damned night.

All hope is not lost but it will still be an uphill battle, especially against the defenders of the PhRMA goons. Already, some Senators - such as John McCain (R-AZ) and Amy Klobuchar (D, MN) have supported legislation that would allow patients to import cheaper drugs from Canada. (Which option had also been foreclosed under the 2003 'Modernization'  Act.)

Others have called for the pharmaceutical industry to justify its rising prices - which I believe is one of the most urgent steps to hold these bastards accountable.  These efforts include one California bill demanding the PhrMA leeches provide a detailed breakdown of costs, including for clinical trials, regulatory expenses, advertising, manufacturing and acquisition costs - and for all drugs that have an annual wholesale price of $10,000 or more.

This is a step long overdue and let's hope it succeeds! For all our sakes!

Chris Christie's Social Security "Solution" Will Get Him Fried On The "Third Rail"

Chris Christie probably thinks he's innovative with his just announced Social Security proposal, but in fact, he's just committed political suicide. He obviously doesn't take seriously the warning of Social Security being the "third rail" when it comes to presidential politics. If he did he'd have paid attention to polls showing that even 58% of Republican base voters do not want the eligibility age for Social Security increased (or their Medicare touched). This in contrast to the Republican donor class, who do.

Thus on Tuesday, did Christie - following the edict of the donor class-  propose the following:

- Reducing Social Security benefits for seniors earning more than $80,000/yr.

- Eliminating Social Security for anyone earning more than $200,000

- Raising the retirement age for Social Security from 67 to 69.

- Increasing the age at which seniors qualify for Medicare from 65 to 67.

The last two, make no mistake, would be especially disastrous, and even Mike Huckabee knocked them - but then he's more in touch with the Reepo base.. Christie, meanwhile,  seems oblivious to the fact that the 1983 Social Security enactment -amendment- which effectively phased in a two year increase in the full retirement age from 65 to 67 - has already lowered benefits by about 6.5 percent.  When fully phased in, the delay of 2 years to defined "full retirement"  effectively cuts the benefits to those born in 1960 or later by around 13 percent. Christie's proposals would nearly double these cuts over time, plus - as Robert Reich pointed out on Chris Hayes' 'All In' last night - ensure even fewer working class Americans live to collect a dime. (For some reason, the hardest working among us - coal miners, sanitation workers, argri-laborers, don't live as long as hedge fund managers and investment bankers. Hmmmmm.....wonder why!)

Christie's proposals don't even (apparently) reckon in the fact that up to 85 percent of Social Security benefits have been taxed for some individuals with incomes in excess of  only $34,000, and  $44,000 for couples. It is almost as if the benefits are given with the right hand and taken away with the left hand of gov't! Worse, because these  thresholds are not adjusted for inflation,  the reduction in benefits increases over time. The effective cut was, on average,  6 percent in 2012  and will be 8.8 percent by 2030 and 9.5 percent by 2050.


As for his Medicare -qualifying age delay, that would render our health care bills even higher. Christie probably believes that those between 65 and 67 will find relief in the existing health care markets but don't buy it.  First, NO health insurance companies are going to compete for senior health care! They only do it now because the Medicare Advantage plans are paid more for their services than the government pays in standard Medicare. Hence, contributing to the standard program’s insolvency (by an excess $12 billion a year according to the GAO).

Second, you can bet your sweet bippy that those 65- 67 year olds will face sky high premiums even for bare bones, high deductible plans. Given their increased health problems (higher blood pressure, cholesterol, weight, type II diabetes, cancer probability) they will likely see premiums of $1,500 a month or more. Many of these oldsters will also already have been laid off jobs to make way for the young Turks, and hence not have the money to purchase anything worthwhile. Thus, they will likely wait for treatment or to see a doc - until their problems become unmanageable. Then WE will have to cough up for their ER visits. But I guess this is what Christie wants. Just like most conservos prefer the bulk of low wage workers go on food stamps rather than increase the minimum wage to a living one. ($15/hr)

As Economics Professor Fiona Scott Morton aptly put it  in respect of another Repuke plan on changing Medicare three years ago (Paul Ryan's "premium support" malarkey):

"The Republican plan is not solving the problem. It’s solving the problem of the cost of government health care. You have people who can’t afford it and they’ll just die. Economists call that demand shedding”.

As for Christie's other proposals:  to cut Social Security for those getting $80k a year or more and eliminating it for those getting $200k a year or more, let's look at some data on Social Security recipients' income distribution to get a grip.  These are from the excellent book 'Social Security Works' by Nancy J. Altman and Eric R. Kingson:

 - 72.5% have less than $50,000 /yr.

- 18.5% have from $50,000 - 99,000

- 5.3% have $100,000 - 149,999

- 2.0 % have $150,000 - 199,999

- 1.9% have more than $200,000

In other words, barely 9 percent of elderly - or 1 in 11, has more than what is regarded as a middle class income. Only 1.9 percent are receiving the cut off point threshold for Christie's proposal. Only about 12 percent if that, would be affected by either Christie's reduction or total elimination proposals.

Given roughly 40 million retired workers are receiving S.S. benefits at a total cost of about 52 billion monthly, Christie's reductions or cuts would have minuscule effect. The math savvy can work it out to a savings of around $4 billion, if that.  Worse, the reductions and cuts for high earners would have exactly the negative effect we can't afford: turning Social Security into a de facto welfare program. 

The solution to solving Social Security shortfalls is simple, but clearly Christie and the Right won't go there. As Robert Reich noted last night, it is simply to raise the payroll tax cap  from its current $118,000 level. 


Christie's recently stated bollocks:

"Frankly Washington is afraid to have a conversation about Social Security with the people of our country. I am not."

Is flat out bull crap, since all "Washington" is afraid of is putting forth real solutions to the problem as opposed to trying to stuff Neoliberal solutions down the throats of an alert and aware populace - who understand that any "entitlement cuts" will even further increase the gulf of inequality.

As the authors of 'Social Security Works' put it (p. 4), our politicos may have polarized us  on just about every issue - from immigration reform to taxes-  but on one we are fiercely united: we support Social Security. This unity forges our future security and is something the Neolibs and their conservo austerity cousins dare not mess with. Hillary also needs to take note and come out four square for Social Security expansion. As Reich observed last night on 'All In':

"What Hillary Clinton can do is completely the opposite. She can acknowledge, because of widening inequality, a lot of working class people don't have enough Social Security and we ought to actually raise Social Security benefits - instead of getting into this debate on whether we should cut them."


 Else prove to us skeptical libs she really is a Neoliberal in progressive clothing. 

Further facts on Social Security:

1) Social Security's  Trust fund has historically taken in more money than it pays out in benefits. Currently it is at $2.76 trillion and continues to grow.

2) Without making any changes whatsoever, current projections show Social Security will be able to pay full benefits through 2033.

3) With just a minor tweak to the payroll tax cap - raising it to a mere $300,000, full benefits would be able to be paid through 2100.

4) The system could easily be rendered 100 percent secure, even with higher disability benefits paid out, if congress would cease raiding Social Security moneys for current expenses, including wars.

America the Swindled - How Big PhrMa Games Us All

As is generally well known, Americans pay the highest prescription drug prices in the world. Drugs to treat diabetes cost 3-5 times more than just about anyplace else, including Europe, ditto for statins (such as Lipitor) and cancer drugs. According to one Big PhrMa honcho, we Americans have to pick up the slack in drug costs given how the rest of the world remains firmly subsidized by their own governments. Translation: their governments actually care enough about them to control drug costs and not let the people get scalped and swindled.

But why should this state of affairs exist? The reason, we are told, is that it costs mucho money to bring decent drugs to the marketplace, the costs of research and all. Hence, unless these costs are borne by someone, some group the research won't get done and the drugs won't manifest - so millions will then have to do without, including the ones getting 'freebies' off us Yanks.

Is this really true, or is it mostly horse manure and PR?

Consider just eleven of the 12 new cancer drugs approved in 2012 which were priced above $100,000 annually. Further, a 20-30 percent copayment can make them unaffordable even to well-insured patients (i.e. those with at least 'Cadillac' health care plans).

But why these outrageous costs? On the one hand the companies claim the high prices reflect high research costs, but on the other hand they insist the high prices reflect the precious "added benefits" of controlling and curing cancer. In other words, the costs aren't really based on current expenses for research but rather future projections of effectiveness such that future health costs don't come to pass. In other words, the current costs of these drugs are really predicated on imagined savings once cancer is cured or controlled.

Is it just me or does this not sound an awful lot like the Neoliberal ploy  (in the “Postal Pension Reform Act of 2006”) requiring prepayment of pensions for 75 years by the U.S. Post Office - which effectively incepted its bankruptcy?  Of course, in this instance we have the future projections of Post Office obligations engendering  monstrous debt - suggesting a need for privatization - which Neoliberals get boners about. But when you think about it carefully the future "benefits" toted up to costs by Big PhrMA also translate to debt - either by the gov't or by the people who have no choice except to purchase these drugs (unless they prefer to die).

A recent piece in the AARP Bulletin (May, , p. 22) provides further insight into the PhrMA gaming on this. Or should we call it Neoliberal faux market gamesmanship?:

"The argument that companies are offering improved drugs for these higher prices is not true. Oncologists find that most new cancer drugs provide few clinical advantages over existing ones. Only one of 12 new cancer drugs approved in 2012 helps patients survive more than a few months longer."

In other words, it's all about milking massive extra profits out of "new" drugs that provide little added benefit. The drug companies, we can conclude, are only in it for profits - and could care less about substantive new research that truly advances cancer treatments.

The AARP piece goes on to puncture more BS:

"The industry argument that high prices reflect huge research and development costs also doesn't hold up - at least given the few facts companies make public .  Indeed, the actual dollars that companies have put into research from 1995 to 2010 have generated six times more revenue than the costs of the research - a sign that they are charging too much for little patient benefit."

Again, we're being led by the proverbial nose to believe a pile of codswallop. And now, if these companies are lying through their teeth on the benefits of the cancer drugs, what about statins and other high priced drugs? It makes sense their benefits are oversold as well (especially given the fact that nearly as many people with low cholesterol have myocardial infarctions as those with high cholesterol.) Not told you is that cholesterol isn't the real bugbear here. Its measurement in a blood test - which often indicated statins to the medical druggies - is really a sophisticated dodge. The real culprit is not cholesterol but c-reactive protein.  This substance indicated the degree of inflammation which is the actual agent triggering heart attacks. The test needed is the one for CRP not cholesterol, but then the CRP blood test is much more expensive.

The AARP article goes on to deal with these inflated costs:

"The most famous industry-sponsored estimate claims that it costs nearly $1.3 billion to develop a new drug and get it approved. This includes the cost of failures. Half that estimate, however, is not research costs at but rather a high figure for profits that companies would have made if they had invested their research money in stocks and bonds instead."

In other words, total Neoliberal perversion of the cost basis. Instead of tallying actual costs to do the research these drug company sharks are tallying up the costs of profits foregone in a whizzing stock market. (They seem to forget that stock markets can crash too.) 

In any case, it isn't a real cost to recoup from customers who faithfully pay up their hard earned money, but rather a phony cost to gouge and swindle them.   As the AARP piece points out:

"Eliminating it brings the actual research costs down from $1.3 billion to $650 million. "

Extrapolating from this, the cost of the typical drug ought to be half of what it is.  Probably less since taxpayers subsidize half of company research costs through credits and deductions granted to drug companies. The AARP author estimates these inputs bring the research costs down to $325 million.  The article adds:

"Moreover, the industry's $1.3 billion is based on a sample of the most costly fifth of new drugs, not the average for all drugs. Correcting this distortion brings company research costs down by 30 percent, to $230 million. "

The AARP goes on to point out the effect of a few expensive projects that inflate the value of the whole, hence why the median is best used instead of the average drug cost. In this case the company cost of research projects dives to $170 million.

The article also exposes more cost pricing gimmickry:

"A final way in which research costs are inflated is by backing in a large estimate for the cost of basic research to discover new drugs. In fact, no accurate estimate exists because the costs of discovery very so much, from an inexpensive lucky break to a costly 30-year search before a new drug is discovered. Removing that inflated estimate for basic research costs brings the net, median corporate research costs down to just $125 million for developing drugs."

Then we also learn (ibid.):

"Overall, basic research by pharmaceutical companies is quite small - about one sixth of overall company research costs and about 1.3 percent of revenues after deducting for taxpayer subsidies. The rest of company research costs foes to developing all those drugs with few advantages over existing ones so they can charge higher prices for them."

In another words, Americans are being swindled by sophisticated market projections, cost inflation, minor changes and other trickery. In the parlance of Neoliberals, it's what's called a "market spiral pricing strategy". It is more or less the same tactic used in inflating the costs of student loans, to increase debt there as well, despite the added costs and burdens being of marginal benefit because the benefits are so low in the existing job market. In the end it is all about enriching the Neoliberal market niche - whether drug companies or banks - at the expense of average citizens.

As the AARP article puts it:

"No other advanced country allows companies to raise prices on older drugs. No other industry raises prices on last year's cars or telephones."

It ends by advising that Congress needs to hold hearings on these spiraling drug prices especially for specialty drugs. In addition, Congress needs to eliminate the stupid rule that prohibits Medicare from negotiating discount drug prices- like the VA does. This dumbass rule entered with the Bushie Medicare Modernization Act of 2003, and was intended to be one prop (the other being Medicare Advantage) to drive Medicare into insolvency.  It should have been repealed under Obamacare, but wasn't.

With rational changes the health care cost curve can truly be bent but it will require gutting the Neoliberal imperative that encourages companies to swindle citizens to make profits. At its heart it means providing incentives for drug companies to provide truly new and effective drugs and powerful disincentives for them to produce only slightly better drugs at sky high prices.

We shouldn't remain hostage to these perverted market and pricing schemes any longer!

Joe Klein – Exasperating “Mediscare” Idiot

Joe Klein is nothing if not predictable. In his latest column ‘Return to Mediscare’  (TIME, April 28, p. 25) he castigates both parties for running ads trying to scare the bejeezus out of seniors in the run-up to the November mid-terms. For Repukes, it’s a chance to once more seek to undermine the Affordable Care Act, while for the Dems in assorted locales, it’s a useful cudgel to go after Repub opponents.

Klein cites Arkansas as a case in point where Dem moderate Mark Pryor is using a woman named “Linda” to warn of his opponent Tom Cotton’s plans to wreck Medicare. The “Linda” ad states that “Tom Cotton voted to turn Medicare into a voucher system”.

Klein then asks" 'Is this accurate?', then replies, “Well yes and no” and classifies it as a “brilliant Mediscare ad.” In qualifying his answer he goes on to write:

“Cotton and 218 of his House colleagues in the House did indeed vote for the Paul Ryan budget, which would slash costs by moving to a privatized (‘premium support’) or voucher system of health care for senior citizens. Is this a bad idea? Probably not.”

Is this guy mad, or just suffering from every day delusions? Of course it’s BAD!

 Let us bear in mind here the maximum "premium support" ever suggested for this absurd program has been $15,000/yr. But the current average senior in Medicare requires support (or if you want, assistance) in the vicinity of $30,000/yr and much more post-86 years of age. This means that at the level of only $1,250 a month, most seniors - unless spectacularly healthy - won't get much help.

Let us assume an elderly woman requires hip replacement surgery at an on-paper cost of $30,000 somewhere in FLA. Today, Medicare - standard Medicare, will pay 80% of that or $24,000, leaving her with $6,000 to pay on her own. A goodly amount,  but not insuperable or break the bank. In premium support at the maximum level, however, the woman would use ALL her allotment for one operation and still have $15,000 left to pay, and no more "premium support" for any other needs that may arise.

In the case of my prostate cancer radiation treatment 2 years ago, “premium support” would have covered $15,000 at most – leaving me with over $35,000 to cover on my own for just the basic high dose radiation treatment. In addition, I’d not have been able to use any further “support” money for any other problems that arose.

 Is Klein this ignorant, or is he just plain stupid?

Economics Professor Fiona Scott Morton (The Market Can’t Cure Medicare’, May 2, 2011) observed that  indeed any such premium support plan, is merely a demand shedding plan. As she puts it, “there’s no evidence many companies will be rushing in to provide health coverage to ailing boomers with competition that ought to lower any premiums"

BINGO!

She added:

"The Republican plan is not solving the problem. It’s solving the problem of the cost of government health care. You have people who can’t afford it and they’ll just die. Economists call that demand shedding”.

Klein then actually compounds his ignorance or stupidity by blabbering:

“”In fact, a more generous version already exists in the form of Medicare Advantage, the private sector Medicare alternative that seems to be going great guns in the Obamacare era.”

But he’s mixing chalk and green cheese. There’s actually no comparison since Medicare Advantage is actually MORE generous than standard Medicare (which the Neolibs keep yapping about cutting).

 Under traditional Medicare the coinsurance is pegged at 20%, but the actual amount out of pocket can be higher since specialists generally charge more for services.  This is not the case for the private Medicare Advantage plans for which the payout limits are often under 20% for special services, because the premiums from standard Medicare beneficiaries are used to subsidize higher specialist and other costs.

This is exactly why, in previous reports, the GAO has reported that the cost -burden of Medicare Advantage plans has added up to $12 BILLION a year to the cost for traditional Medicare and why the latter's headed toward insolvency. Of course! Because the Advantage plans are like parasites bleeding it down! Does Joe Klein mention any of this? Of course not!

The point is the Advantage plans are required to offer a benefit “package” that is at least as good as Medicare's and cover everything Medicare covers, but  usually they offer much more!  Plans that require higher out-of-pocket costs than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits, plus use some of the excess payments they receive from the government for each enrollee to offer supplemental benefits.

But this in NO way is similar to Ryan's voucher ("premium support") plan which would offer a single fixed voucher in a designated amount (e.g. $10,000) - from the government - to have to go out and actively snag a private plan (hoping it will accept the senior)  and the limits of the voucher to cover future costs of visits, care over the year. By contrast, once a senior chooses a private plan in the sphere of Medicare Advantage there are no 'ifs, ands, or buts' - he will be allocated a  private plan and can't be denied for pre-existing conditions or any other balderdash.  The private insurers also know it's a good deal for them since they're assured of regular monthly payments from the gov't which have the potential of increasing each year! No fixed, one time, voucher pays!

Another goodie for the Medicare Advantage senior: Advantage plans typically do not contain deductibles, thereby giving members "first-dollar" coverage. (Original Medicare has a potentially recurring (more than once per calendar year) deductible for Part A and an annual deductible for Part B.) Ryan's plan by contrast will likely see private health insurers attaching massive deductibles, on the order of $3,000 -$5,000 or more, for the simple reason that the insurers will be having to take chances (with no regularly promised gov't subsidies, only the single voucher payment) with a person in a putative high risk health pool! It doesn't take a genius to see that with such deductibles in play, and assuming the private insurer even accepts the senior, much of the voucher will be eaten up before the first real care is even delivered.

The sad fact here? Klein actually has the freaking nerve to assume (and entice his readers to believe)  that Ryan’s premium support voucher plan is little different from Medicare Advantage and would not be different if the Repukes ever got to implement it.  The Pryor ad which he castigates as “Mediscare” by contrast, is realistic enough to grasp that would no more transpire than aliens landing from Tau Ceti landing and abducting the whole GOP House.

What can we conclude? That the Mark Pryor ad is spot on in its perceptions, and that Klein’s bullshit is not to be trusted. But then, no Neolib hack’s is, whether Klein, Robert Samuelson or any other puppets.