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Essential Reading: Laszewski on Rove and Medicare D – Brian Klepper

All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D.

Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succinct piece called "Good Riddance to Karl Rove: How Part D Left An $8 Trillion Debt And Got Them Nothing," a genuinely damning indictment of the cynical use of power. Read Mr. Laszewski’s posts and you quickly get the fact that he is a keen, unbiased, open-minded, analytical observer of the Washington health care scene. His obvious knowledge about the circumstances and his stature lend terrific weight to his words. I’d urge every person who reads this blog to read Mr. Laszewski’s column, and to pass it around to your colleagues.

I was a distant observer of the Medicare D debacle, but close enough
to know some of the key players behind the scenes, some of whom have
moved onto greener pastures. (Among the most visible and loathsome was Rep Billy Tauzin
(R-LA), who helped design and shepherd passage of the bill, and then,
on the day he left Congress, assumed the leadership of the Pharmaceutical Research and Manufacturers of America (PhRMA).)

There were big winners all around: the Fortune firms who got a
significant part of the largesse in the form of very rich retiree drug
benefit subsidies; the drug companies, who got a new subsidized market
at very high rates, and the health plans, who instantly had a new, very
lucrative product, financed by Congress.

D is a program that is filled with holes, apparently by design, and
that encourages outright abuse by less ethical health plans. If you
doubt me, read this article on oral cancer drugs cost variation among D plans.
Seniors who have the misfortune of choosing the wrong plan to be on
when they discover they have cancer can have to pay the value of a
house to get access to some drugs on the plan.

D was hugely irresponsible, expensive and deceptive public policy,
designed for the industry rather than recipients and at extraordinary
expense to taxpayers. As Mr. Laszewski points out, "Make no mistake, seniors deserve a drug benefit, but they deserve one that is part of a reformed Medicare system that is sustainable."

That is true, but its his closing line that is the sum and substance of why D was a pure act of worst kind of politics.What’s the point of winning in the
first place if you only use the platform to win the next one and leave
$8 trillion in unfunded liability in the process?

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8 replies »

  1. Oncologists have made more money by infusing chemo and supportive drugs in their offices than they have by prescribing oral ones…so guess how frequently patients get infused?
    Of course, infusion of chemo necessitates the often extremely ill patient to schlep to the office, sit through hours of waiting, enduring infusion, etc. But the docs get paid.
    The MMA sought to go further with dismantling AWP and other perverse incentives in oncology. Monied interests (drug companies, ASCO) won out…

  2. Thanks much for your very gracious comment, Neimon. If it makes you feel any better – and it shouldn’t – we’re all guilty of the same foible way too often. Few of us are so willing to turn it around once we’ve been caught.

  3. I have been told (privately) that my comment was out of bounds. Certainly it fell into the category of ad-hominem, for which I apologize deeply.
    In my factual ignorance, things sometimes seem simpler – or more, for want of a better noun, just plain evil – than maybe they are. Certainly I wouldn’t claim that “healthcare” is a simple thing.
    As a technologist, I have the deepest respect for physicians as practitioners, and as information systems. What I don’t understand is why we must argue about how to pay for something before we can even agree that everyone deserves it. To me, the former will follow the latter. Like I said. I simplify. But sometimes that’s my job.
    As such, I used the wrong-colored glasses in this case and brought an irrelevant dog to the fight.
    I hope Mr. Pawelski will accept my profoundest apology for any sense that he may be acting in a less than benevolent fashion. Ignorance is not bliss, and humility is hard to come by. I practice the former all too easily, but try to make up for it with the latter. Often I fail.

  4. Brian,
    re: the “inappropriateness” of Neimon’s comment, may I suggest that while it may not be the height of decorum, it IS emblematic of the nature of healthcare policy ‘debate’ (debate in our era being the spectacle of people of contrasting views talking entirely past one another, deaf to synthesis).
    So in that sense perhaps its appearance here is entirely too appropriate.
    My personal hobbyhorse is that none of us (however putatively noble or evil our intentions) should employ the ‘healthcare’ lightning rod in our discussion of “The Topic” at all – we should recast the discussion with entirely new nouns, if for no other reason than to get on with making something better of our current circumstances.

  5. Dear Neimon:
    Your comment is inappropriate. The data are clear that oral cancer drugs can be far more efficacious. Mr. Pawelski is correct that, to the degree that they can supplant intravenous drugs, they both improve people’s lives and save money.
    I have watched Mr. Pawelski’s writings for some time. He is a scholar of the highest order on this topic – he also has direct personal experience that none of us would wish to go through – and I’ve never known him to be motivated simply by what costs less.
    This is a forum that, above all, strives to be professional and data-driven. Let’s try to keep it that way.
    Thanks.

  6. Only in an overtly winner-take-all-and-the-sick-are-morally-weak society, in which human life has a dollar value, and we argue over how to spend billions of dollars to line the pockets of corporate swine whose strategies are to DENY care to the needy, would we get this kind of double speak:
    “Taking your medication at home allows you the freedom to carry on with their daily lives. less time spent in hospitals and private oncology practices because of the absence of intravenous administration and its related side-effects.”
    Ah. Not receiving professional care is a FEATURE now. I see. Just take the pill and shut up. Give me your money and don’t forget to die at home, please, because otherwise we have to pay someone somewhere.
    Well, so long as it’s cheap…

  7. Hey! I was raised in a mom and pop grocery store. This is where I developed my private enterprise spirit (except when it comes to health care). For years, I helped my dad make the best polish sausage in the county. It’s not that bad to see being made. You should get some hands-on experience making it. Maybe you’ll get a better appreciation of it?
    Granted, the D program was filled with holes. The biggest problem was in designing the program. This administration did not want the Medicare drug benefit to be administered directly by the federal government (where Medicare is run efficiently). Instead, it devised a public program run by hundreds of competing private plans, each with its own prices and coverage policies (confusion???).
    But the new Medicare drug benefit plan was part of a much broader message. With oncology drugs accounting for about 69% of total Part B spending on prescription drugs and related services, the new D plan made it more important for Senior cancer patients.
    With it, Senior Americans with cancer for the first time, did not even have to go to hospitals, let alone the infamous infusion rooms of office-based oncology practices. That’s because the plan D offered them benefits they did not have before, such as coverage for oral chemotherapy drugs. Because it is a pill, patients can take it at home with only occasional visits to the doctor or clinic.
    Oral chemotherapy drugs are treating cancer just as effectively and enhancing the quality of treatment for cancer. They can make treatment more convenient by allowing flexibility, without disrupting work or other activities. Taking your medication at home allows you the freedom to carry on with their daily lives. less time spent in hospitals and private oncology practices because of the absence of intravenous administration and its related side-effects.
    And, according to an article published in the New England Journal of Medicine, an unintended effect of the Medicare Part D benefit could be the creation of the world’s most valuable resource for understanding how drugs are used, especially by the elderly and the chronically ill, and their risks and benefits.
    http://content.nejm.org/cgi/content/full/353/26/2742

  8. Matthew,
    I was surprised by any commentary on Hilary’s up close and personal HEALTH visit with a nurse in Nevada. Why would the SEIU believe that a nurse who is the picture of ill-health with obesity and Type II diabetes and high blood pressure ever be a good advertisement for Hilary’s health care policies. Mike Huckabee is way ahead on this health/disease debate.

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