Medicare Part D – The Health Care Blog

Why the Medicare Part D-Obamacare Comparison Is Making Less and Less Sense

Oct 31, 2013• 14

By Dan Diamond

With the possible exception of one phrase — “it’s a marathon, not a sprint” — defenders of Obamacare have repeatedly invoked the same warning.

Don’t be too critical of the Affordable Care Act’s new marketplaces. Medicare Part D had a rocky rollout, too.

“In terms of confusion, lack of knowledge, and misinformation, the current situation with exchanges resembles the situation that prevailed when Part D enrollment opened,” Daniel McFadden, a UC-Berkeley economist and Nobel laureate, told the Wall Street Journal‘s David Wessel earlier this month.

Part D, “at the time that it was passed was actually less popular than the Affordable Care Act,” President Obama said in an NPR interview on Oct. 1, the day the new marketplaces launched.

There are similarities between the two programs, from the political fight over their enactment to the difficulties in making the laws a reality. But the laws differ in some important ways, too, including ones that supporters haven’t fully acknowledged.

So what can we take away from Part D? Here is a quick guide to lessons from the drug plan’s rollout.

The political environment

How it’s similar: Just as Democrats fiercely resisted Republicans’ efforts to enact a Medicare drug benefit, the GOP refused to support the Democrat-led ACA.

How it differs: While Part D is seen as successful today — 90% of seniors were satisfied, according to a 2009 survey — Democrats say that their party deserves some credit.

“We lost the policy fight, and what did we do?” asked Rep. Bill Pascrell (D-N.J.), at a hearing on Capitol Hill on Tuesday. “We went back to our districts and we told our seniors although we voted no, we … will work with the Bush administration to make it work,” Pascrell added.

Why You Should Care About the Drugs Your Doctor Prescribes

Jul 16, 2013• 25

By Charles Ornstein & Tracy Weber

The following column appears today on THCB, in the op-ed pages of the Los Angeles Times and at ProPublica.

Your doctor hands you a prescription for a blood pressure drug. But is it the right one for you?

You’re searching for a new primary care physician or a specialist. Is there a way you can know whether the doctor is more partial to expensive, brand-name drugs than his peers?

Or say you’ve got to find a nursing home for a loved one. Wouldn’t you want to know if the staff doctor regularly prescribes drugs known to be risky for seniors or overuses psychiatric drugs to sedate residents?

For most of us, evaluating a doctor’s prescribing habits is just about impossible. Even doctors themselves have little way of knowing whether their drug choices fall in line with those of their peers.

Once they graduate from medical schools, physicians often have a tough time keeping up with the latest clinical trials and sorting through the hype on new drugs. Seldom are they monitored to see if they are prescribing appropriately — and there isn’t even universal agreement on what good prescribing is.

This dearth of knowledge and insight matters for both patients and doctors. Drugs are complicated. Most come with side effects and risk-benefit calculations. What may work for one person may be absolutely inappropriate, or even harmful, for someone else.

Antipsychotics, for example, are invaluable to treat severe psychiatric conditions. But they are too often used to sedate older patients suffering from dementia — despite a “black-box” warning accompanying the drugs that they increase the risk of death in such patients.
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A Model for Health Care Reform:Would You Guess Medicare Part D?

Apr 4, 2013• 11

By Hank Pomeranz

Every day, over 7,600 baby boomers turn 65. By 2029, this number will rise to over 11,000. As more and more Americans approach senior citizenship, health care for seniors through Medicare becomes increasingly relevant. The question is, how will this affect you?

We all have questions about how the current budget battle and resulting spending cuts are going to impact Medicare. It seems unavoidable that Medicare costs will have to be reduced in some manner. Both Democrats and Republicans have proposed fixes to counteract these budget cuts. President Obama, in his State of the Union address, recommended adjustments to Medicare Part D that would enforce mandatory rebates–in other words, price controls–on drug companies.

But we need to ask ourselves: why would we make changes to the most successful part of Medicare by far? Polls indicate that 90 percent of seniors are happy with their current Part D coverage. Not only is Part D popular; it is also cost effective. It has cost 30 percent less than originally estimated. Premiums are an average of half the price originally estimated. Meanwhile, price controls are estimated to increase drug costs by 40 percent. Clearly, they are not the answer to cutting Medicare costs.