Abolish Medicare Part D? Just heard that the President would be in favor?

[Change Happens]

I think it is a great idea...Part D is the Medicare drug plan Bush passed and never funded. This is worth trillions in savings inside this debt/deficit debate over the next 10 (or 50) years!

What do you think?

Edited to add: many, maybe most of these plans are inside the Medicare Advantage plans the HMOs keep selling, this will be a HUGE blow to both, the HMOs AND the drug companies :)

[peacebird]

1. Great idea! Abolish it and allow Medicaid to negotiate same savings on prescriptions

as rest of federal insurance and/or military insurance coverage - whichever is best.

[proud patriot]

7. +1

[DURHAM D]

11. Medicaid?

[madfloridian]

46. Are you confusing Medicare and Medicaid? Please explain.

[peacebird]

61. argh - i meant Medicare... For some reason I get dyslexic and type "medicaid? when I mean "medicare"

[KittyWampus]

65. Exactly! This plan has the potential to be a huge win for America and Democrats.

[flamingdem]

2. Dems know where the republican fat that needs to be cut lies nt

[sasha031]

3. it would have seniors in an uproar

they should negotiate for lower drug prices outside the US

[Cleita]

4. I agree. It doesn't have to be abolished though, but

put in a caveat that Medicare can bargain for better drug rates like the VA does. Also, make it government single payer and get the insurance companies out of it.

[Morning Dew]

5. Part D was a giveaway to insurance companies.

It never should have been enacted in its current form.

[sasha031]

10. people use to buy their drugs overseas

with part D W made that impossible,
someone mentioned the VA, good idea

[still_one]

6. I think a lot of people would be pissed, and hurt. Perhaps if they allow drugs from Canada that

might change things, however, I doubt the pharmaceutical lobby will allow that

[indurancevile]

69. if they were able to negotiate group discounts it would be a win.

Bill to Let Medicare Negotiate Drug Prices Is Blocked

By ROBERT PEAR
Published: April 18, 2007

WASHINGTON, April 18 — A pillar of the Democratic political program tumbled today when Republicans in the Senate blocked a proposal to allow Medicare to negotiate lower drug prices for millions of older Americans, a practice now forbidden by law.

Democrats could not muster the 60 votes needed to take up the legislation in the face of staunch opposition from Republicans, who said that private insurers and their agents, known as pharmacy benefit managers, were already negotiating large discounts for Medicare beneficiaries.

http://www.nytimes.com/2007/04/18/washington/18cnd-medicare.html

Part D is responsible for a big chunk of the medicare cost rises recently.

[katmondoo]

8. Yes Yes Yes

A mad idea to begin with that only a Bush could think of.

[cbayer]

9. This is a terrible idea.

Although Part D is flawed, I believe many of it's problems are being addressed in upcoming healthcare reform.

Without Part D, seniors would once again not be able to get their medications. Most seniors on Medicare do not qualify for medicaid.

[Davis_X_Machina]

15. Maybe it's just me, but I think a measure...

...narrowly tailored to offend the very voters who just put the GOP into their present House majority with a 70-seat swing, on the back of "Obama is going to kill your Medicare", is an excellent idea.

[cbayer]

I will let my extremely liberal 80 year parents who depend on it know.

Where did the idea that seniors put the GOP back in power come from? I know a lot of very progressive, politically active Democratic seniors who would suffer immeasurably if this were done.

This is in no way narrowly tailored.

[aquart]

24. A poison pill, as it were?

And Bush's Legacy?

[Davis_X_Machina]

26. No, I'm just one of the DU'ers...

...who thinks Sending a Message is way, way more important than winning elections.

[WinkyDink]

30. Oh, one of THOSE smart-alecs. ;-)

[Davis_X_Machina]

32. Alas! I have been found out! n/t

[aquart]

58. Yeah, it was real smart of us to think that way right before re-districting.

Damn geniuses we were. What was that message again? Think anyone got it?

[DURHAM D]

16. I thought that the reform act only slighty changes the donut hole.

Did it do more?

[cbayer]

19. The donut hole was by far the biggest problem in the plan.

I can not honestly say what else might be addressed, but fixing that resolves the major issues with Part D, imo.

[Bluenorthwest]

25. One assumes your folks are also drifting on a sea of cash

because the major problem with D is that it made it illegal to negotiate drug prices from Canada and other places. The doughnut hole is also not even close to being closed as yet, and it will be years until it is closed under the current plan. Only those with tons of money do not care how much it all costs.

[cbayer]

36. My mother is dirt poor and I paid all of her donut hole expenses for her breast

cancer treatment. Her measly SS check, however, places her out of medicaid range in the state she resides.

You are correct that the Part D legislation made it illegal to negotiate drug prices from Canada, but prior to part D, drug price negotiation wasn't even an issue. Medicare covered no pharmaceutical expenses for patients prior to part D. None.

[DURHAM D]

28. Not really - it absolutely has to be changed to allow

bulk buying agreements/pricing. Like the VA.

The donut hole costs the Medicare consumer. The non-negotiated prices cost the consumer and the government. We all buy Part D coverage from private insurance companies. The cost doubled in 2011 for me. I don't, and never have, taken any medication. In 2010 Part D cost me $19 a month. It was the cheapest I could buy. In 2011 in went up to $39 a month. That was the cheapest insurance available in my state. Again, I don't take any medication.

So, Part D was a gift to the drug companies and a gift to the medical insurance companies and a pox on the people and Medicare. And, Obama cut that deal without the knowledge of Pelosi.

[cbayer]

52. You are correct. I was addressing this more from the patient's perspective in terms

of where the major problems laid.

There are many other problems that need to be addressed. I am a strong advocate of the government negotiating pharmaceutical costs from whatever sources they can.

It is wonderful that you are not on any medications and I hope it stays that way. Particularly if Part D is eliminated without a substitute plan. Even the simplest of meds is likely to cost you a great deal more than $39 a month.

[Bluenorthwest]

23. cbayer, NO one on Medicare qualifies for Medicaid. Not 'most'

none. If a person qualifies for Medicare that automatically means they do not do so for Medicaid.

[DURHAM D]

31. Low income people over 65 with low incomes and no assets

can qualify for Medicaid.

[slipslidingaway]

40. Links - dual eligibles ...

http://www.kff.org/medicaid/4091.cfm
http://www.cms.gov/medicare-medicaid-coordination/

[cbayer]

42. This is not correct, Bluenorthwest.

There are many, many dual eligibles in this country. Medicare is based on age or disability. Medicaid on income and assets.

Many Medicare patients have to "spend down" (that is, spend all of their assets) to qualify for Medicaid. Many people are forced to do this in order to get services not covered by Medicare like nursing home treatment.

Prior to Part D, many patients had to do this to get coverage for their medications through medicaid.

[Obamanaut]

68. My 96 y.o. MIL who lives in a nursing home does. My Medicare handbook

has several references to people who have both.

I think one CAN have both.

[KittysRfuzzy]

12. It is still unfunded

It is paid for with borrowed money, good riddance.

[bigwillq]

13. Hello.

Welcome to DU! :hi:

[Name removed]

21. Deleted message

Sub-thread removed by moderator. Click here to review the message board rules.

[RKP5637]

14. A major problem is they can not negotiate for the cheapest price. It was a giveaway

to the insurance companies. It was a money loser from day one. It was not meant to serve the best interests of the country/seniors, but rather to lavish money on the pharmaceutical industry.

[Bozita]

47. ... to Billy Tauzin who 'found' a lucrative job as top lobbyist for Big Pharma after leaving Cong.

The good ol' revolving door.

[RKP5637]

51. These guys are slipperier than eels as they slide around from one money maker to the

next often IMO with absolutely no regard to what's best for the people and the country.

[Dawson Leery]

17. It would certainly save money for patients. Part D is corporate welfare

for the pharmaceutical giants, which is why the GOP supported it.

[cbayer]

20. How would it save money for patients? There is NO other provision in Medicare

to pay for medications. None.

Prior to Part D, seniors had to purchase all of their medications out of pocket.

No question that the Republicans wrote it to benefit the pharmaceutical industry and that it has major flaws, but to eliminate it would be disastrous for patients.

[William769]

29. You are correct.

And people like me with AIDS would basically be given a death sentence. In Florida right now there are 3,550 waiting to get on the ADAP program. This year President Obama cut ADAP spending by 25 million dollars Frloida went from 6.9 million down to 3 million. If we lose Medicare part D, that list will double to triple in size & thats just the waiting list. The worst thing you can to to a AIDS patient is start his anti viral medicine then stop it.

Some People Just do not realize that Medicare prt D has saved lots of lives.

[DURHAM D]

33. But you would agree it needs to be fixed. ?

[William769]

35. Fixed yes. Abolished no.

[DURHAM D]

41. How about a whole new program - Medicare Part M (for medications)

[William769]

49. Medicare part D is already just for Prescriptions.

So I don't follow you.

[DURHAM D]

53. Part D is too poorly constructive to really be fixed.

It needs to be replaced. It needs to start with the goal of providing drugs to those on Medicare or Medicaid at a reasonable rate.

Instead it was constructed to benefit pharmaceutical companies by allowing them unlimited billing/access to government funds and allow insurance companies to over charge seniors because of the "inflated" cost of drugs.

The legislation was built backwards.

[cbayer]

55. One small correction. Part D does not apply to medicaid patients at all.

Medicaid covers medications at little or no cost to patients in most cases.

Only the very, very poor, children and pregnant women generally qualify for medicaid.

[DURHAM D]

66. Question -

Re: "Medicaid covers medications at little or no cost to patients in most cases."

Under what government program are Medicaid drugs paid for. And, is bulk purchasing allowed? I assumed its was covered under Part D since 2006 or some sort of similar program.

[cbayer]

70. Medicaid is administered at the state level with federal funding support.

CMMS (Centers for Medicare and Medicaid services) oversees the state programs and some of the federal regulations, but the bulk of administration and actual payment is made at the state level.

I believe that some states do have bulk purchasing power. Part D is not a factor in medication finance for medicaid at all.

[DURHAM D]

71. From Wikipedia - (sorry)

"Dual eligibles (those also eligible for Medicaid benefits) were transferred from Medicaid prescription drug coverage to a Medicare Part D plan on January 1, 2006."

The issue (problem) with Part D is not the benefits. The administrator is not the issue.
It is the elevated and unregulated cost of the drugs that are being expensed against Medicare.

[cbayer]

73. I was not aware of that and thank you for the information.

I was involved with implementation of the Medicare Part D bill (a total nightmare) until November 2005 and completely missed this.

[cbayer]

75. Just adding another link about this here.

http://www.kff.org/medicaid/upload/7454.pdf

[DURHAM D]

80. So, can we agree that the issue with Part D is the billing?

Can we further agree that no one in this thread wants to take down a prescription drug program for seniors, disabled, and the poor.

But, it is in everyone's interest to get a handle on the amount expensed against Medicare.

Several have stated that it was a give away ($$$$) to the pharmaceutical and insurance companies. That is a true an accurate statement once you realize that the costs are not controlled. But that can and must be fixed.

Ok?

[cbayer]

81. DURHAM D, I think we are on the same team here.

I think there are a number of members here who do not know enough about the program as it currently exists and that much good information has been shared.

I know that I learned something very important about dual eligibles.

I still completely reject the OP's premise that Medicare Part D should be abolished, but I absolutely share your belief that the program needs to be entirely revamped.

Cool?

:toast:

[cbayer]

82. Just one point I wish to make here. What you say is true about dual eligibles,but straight

medicaid recipients still have their pharmaceutical costs covered at the state level. I think that is where my confusion came in.

[DURHAM D]

83. Well that would be interesting.

Medicaid programs are administered by the state but at least 50% of the funds for the program are from the federal government.

You seem to be saying that although the funding is split between the feds and the states generally the feds opt out completely and provide no monies for the drug benefits portion of the program. IOWs you are saying the state picks up 100% of the expenditures for drug benefits.

Is that right?

[cbayer]

85. Not exactly. Although 50% of the funds come from the feds, the states determine

how the programs will be budgeted and administered. Some states have tight formularies, some don't. Some states require copays for meds, some don't. Some states are negotiating with pharmaceutical companies, some aren't.

At least that how it was last time I looked closely at it.

What I am saying is that the monies from the feds are not designated for anything in particular.

[DURHAM D]

86. Thanks.

Do you happen to know which ledger(s) the fed's Medicaid funding is expensed against?

Isn't it all expensed (provided by) the Social Security Administration? If it is all from the SSA do they split expenses across various budget groups? If so, I would bet Medicare still gets charged for some (if not all) of the drug expenses. Thus another reason why Medicare is struggling and SS has challenges.

What I am trying to ask is does the federal government fund Medicaid with general revenue or did they just dump it on the SSA. The SSA is supposed to be self-funding but can't remain viable if new stuff is dropped on the department without new revenue.

We wake up one day (like now) and the President says it is in trouble while avoiding a conversation about the fact it has been abused by the legislature and the WH over the years. I am not just talking about Medicaid. I am talking about child benefits, disability benefits, etc. and other things that have just been added to the SSA tab without recognizing the expense and increasing the funding.

Don't get me wrong - I am all for increased benefits, I just don't like the setup of layering on expenses for the department and then screaming about the deficient funds.

[cbayer]

87. Above my grade pay at this point. I just don't know the answers to these questions,

but they are great questions, imo.

It's been my pleasure discussing this with you, DURHAM D.

I hope we get the opportunity to talk again.

[William769]

59. We will have to just disagree on this.

My total cost for prescriptions for one year is about 27 grand. After 4600 Hundred dollars and included in that is about 500 dollars out of my pocket comes from the Government. The rest is paid by healthnet orange who cover my part D. Grant you that not the case in all patients, it just goes to show they do not have a free ride.

[DURHAM D]

67. William -

The issue is not what you are receiving or paying for. The issue is the amount the government is paying out on your behalf. Under the current program (Part D) the government is being over billed.

[green prol]

74. Medicare for all would do it.

That along with the expiration of the tax cuts for the rich would save ooddles and gobs of money.

[cbayer]

34. Shout it from the hills, because based on what I am reading here, many people

do not understand this at all.

You are correct. This would not only be a death sentence for many seniors but for many others with chronic illnesses.

[Dawson Leery]

39. Then it needs to be modified to beneift the patient.

[cbayer]

62. Totally agree, but abolishing it without something better is not an option, imo.

[Doctor_J]

76. It would have to go WITH Medicare drug-shopping

[Faygo Kid]

18. Ask seniors who can't afford their drugs now. And it won't just be Part D.

Part D is deeply flawed, but it helps pay for essential drugs. I'm not surprised that its elimination is being talked about, but if you think Obama and the GOP will stop there, I have a bridge in Brooklyn to sell you.

The destruction of Social Security, Medicare and Medicaid is going to be on the table. And sooner, not later.

[LaValle]

22. Right Take More from the Poor And keep giving the rich Tax Breaks nt

[rox63]

27. My Mom depends on Part D for her meds

Allow Medicare to negotiate drug prices. That would save a lot of $$.

[DURHAM D]

37. I would like to know where you heard Obama is for dumping Part D.

Obama secretly negotiated with drug companies and insurance companies to keep the damn thing just as it was during the HCR negotiations. He propped it up - why would he want to dump it now?

The insurance and pharmaceutical companies are still his funders for re-election.

[madfloridian]

38. You never put any links.

That's weird.

[DURHAM D]

43. are you suggesting the OP is a shit stirrer?

[madfloridian]

57. I have no comment.

[Roselma]

44. I agree...I've been helping a friend with her Medicare, and it

has been a pain in the a$$ accounting for her Part D. She hit that donut hole in 2009. I think that the government should directly negotiate bulk pricing on brand name pharmaceuticals for seniors. Pharmaceuticals should then be a placed under Part B and the card used for B should be used at the pharmacy. There should be a slight increase in the monthly cost of B. There never was a need for D and its complicated framework, when B already existed. I also think that the government should work with major mail order pharmacies for even greater discounts for maintenance meds. Part D was written by pharmaceutical companies for the benefit of pharmaceutical companies. Once Part D is eliminated and rolled into B, then there would be little reason for Part C (medicare advantage plans) which cost the government 14 percent more than regular medicare.

[DURHAM D]

45. very well said

thank you

[cbayer]

48. I agree with much of what you say here. But until medications are included under

Part B, the elimination of Part D should not occur.

The bill was badly written and definitely benefitted the pharmaceutical industries, but for most Medicare patients, it was a lifesaver.

[marions ghost]

77. the donut hole

is the cruelest invention ever to be inflicted on those with chronic illness. :-(

Yes, put medications under Part B.

[William769]

50. I see alot of talk here, does anyone know how Medicare part D works?

[DURHAM D]

54. It looks like several posters in this thread do.

[William769]

56. Not to me.

[mitchtv]

63. Yeah, I do, I'd be dead without it (transplant)

no good getting rid of it, now that my ex employer has taken drugs off my plan and given me the "orange "plan to work with Medicare. They (AT&T) were paid handsomely to do so. destroy Part D, and do you think they will add drugs back on my retiremnt HMO?

[William769]

64. I agree with you.

My point is very few know what they are talking about.

[Yo_Mama]

79. Yeah

It's actually a very good deal, although seniors do have to pay a decent chunk of change for it.

It's a good deal for the taxpayers, because drug costs are too high for the elderly. If that 68 year old doesn't get his/her BP meds, insulin/diabetes meds/statins, etc, the general public is going to be paying for a whole hell of a lot of extra hospital stays.

One of the few good things Bush ever did. Initial cost estimates have proven to be way overblown. The program does require seniors to pay for drugs, but it generally makes them a lot more affordable.

Cutting seniors off this would literally kill and maim many of the poorer elderly. Premiums for Part D for better-off retirees were raised in health care reform, and that starts taking effect in just a few years.

I would have expected to see this thread in a GOP or libertarian forum, not on something with the word "Democratic" in it.

I would love to know how everyone thinks older people living off a $1,200 monthly SS check with over $110 subtracted for their Medicare premium is going to afford a $380 monthly drug bill? Do tell!

On page 218 of the 2011 Medicare Trustees report, you will see a table showing cost per beneficiary for different pieces of Medicare. Note that in 2010, Medicare Part D cost hardly more per beneficiary than in its first year, and HI costs have grown at a more controlled rate:
https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf

I have spoken to many doctors who think the Part D program has made a big difference in controlling costs for many of their patients.

[alcibiades_mystery]

60. They lied to get it passed, and Dems opposed it in droves

It was and remains the only major completely unfunded social protection program, a pure give-away to Big Pharma. It's a catastrophe, and part of the reason why we're here today.

Bush essentially bribed seniors with it, and left the inevitable budget problems that would come from a pure give-away of th Treasury to Big Pharma for the next guy to deal with. If Medicare Part D went bye-bye, it would be a good start. Figuring out a way to fund it directly with corporate tax dollars would be even better. As it currently stands, it was Bush's way of preventing what was then on the horizon: aggressive and competitive negotiation with drug companies that would put downward pressure on their ridiculous and at times collusion-based pricing strategies. Reducing the time of the patents would also help.

[Drahthaardogs]

72. Killing it would be great!

As long as they actually allow negotiation with drug companies, which as of now, are not allowed.

[TheKentuckian]

78. I hate Part D but you have to figure out how seniors will get their medicine or

you have a political suicide/actual murder situation on your hands.

Reality is health care is too big of a fucking mess if you don't go single payer and because of the profit motive throughout the system we may have no choice but to go to a NHS to actually get all the pieces in line so we can control the overall systemic costs.

[bluestateguy]

84. I opposed that bill when it passed

There should have been direct negotiation with the drug companies and cutting the private Rx companies out of the loop.

The late night back room tactics DeLay and Hastert used were revolting.

Having said that, to repeal Part D all together and replace it with nothing would cause great pain for millions of senior citizens, so I can't support that.

[dawg]

88. What a profoundly bad idea.

Despite its flaws, Part D helps a lot of people. Is there any part of the safety net that certain people do not want to cut?