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Today a friend brought to my attention an article in the Washington Post entitled The not-so-sweet side of closing ‘doughnut hole.’ The part of the article that is most pertinent to me is this:
The closing of an unusual gap in Medicare drug coverage — a gap that Republicans had, when they controlled Capitol Hill and the White House, insisted was needed for the government to be able to afford the program — would "forever end this indefensible injustice for American’s seniors," Senate Majority Leader Harry M. Reid (D-Nev.) said in announcing that the Senate would join the House in supporting the change.
But details of the change underscore that, for patients and the federal budget alike, the implications of the sprawling health-care bills pushed through by congressional Democrats are more nuanced than lawmakers’ talking points.
The Democrats and President Obama have been clear that the "doughnut hole," as the gap is known, would disappear gradually over the next 10 years. They have not mentioned that Medicare patients would, according to House figures, face a slightly larger hole in coverage during two of the next three years than they do today.
Just so y’all know I’m in that doughnut hole as we speak. I got there in Sept. and won’t be out until after the first of January, if then, since I’m switching insurance companies (or trying to.) This stuff is not just policy to me; it’s reality.
While they’re fixing things, I can only hope someone thought to fix the two year waiting period for folks who have been accepted for Social Security Disability benefits to become eligible for Medicare. I’ll never know what twisted rationale there is behind that nonsensical regulation. Logic dictates that if a person needs disability benefits because they can no longer support themselves, they obviously need medical care but have no means to pay for it.
All in all, the bill they’re threatening to pass is full of many "nuances" that seem more like flaws to me. I couldn’t be more disgusted.
58 Comments
Thanks Ann – recommended.
The wait for Medicare, for disability recipients, is clearly in the “hope you die” category. It’s unconscionable.
Thanks for this report, Ann. Good luck to you!
katymine died before she got medicare. i truly believe that 18 month waiting period is the govt wanting those in need to hurry up and die before they qualify for help.
Rec’d.
Pulling for you and millions in this trap.
I’d like all the senators and representatives to be in this exact situation. There just is no good reason–no bad reason, no reason at ALL, that we can put a man on the moon but we let our citizens suffer like this. This is cold, wrong and stupid.
Now that’s a policy I like! While serving in the Senate or House (or White House), members fall within a “donut hole” of ZERO coverage. No insurance, no drug benefits, NADA. ALL medical care must be out-of-pocket…until/unless we get universal healthcare.
That should be an Amendment to the Constitution!
Absolutely.
The two years my mom was on Medicare Part D she reached the doughnut hole in May.
I’ve been on Medicare for two years. I haven’t hit the doughnut hole because I’ve simply accepted that the biotech arthritis treatments are out of reach. When I heard the gap might be closed but not until 2019 I confess there was only the slightest uptick in my disgust with the Democratic Party… because I was almost completely disgusted with them already..
Ditto. I can relate.
I guess an adjunct to the making of policy and sausage analogy in this era of Obama is that you don’t want to look to look at the outcome of either one under a microscope, or even up close with bifocals.
Once you really see what you’re getting policy- and sausage-wise…
I found this calculator on Kos….from Kaiser. It speaks volumes….about what the HCR bills really mean in dollars and taxes. Mandates away.
http://healthreform.kff.org/SubsidyCalculator.aspx
Jon Walker has a few caveats on that calculator fwiw
My senators voted for Medicare D back when it was originally passed and, in response to complaints from me about both the donut hole and the lack of price negotiation, one normally reliable Dem senator said, essentially, “Don’t worry… this is just a start and we’ll fix the problems as we go along.”
Hah! Has any serious “fixing” taken place? I don’t think so–including this latest round. Why is it my aunt–a senior in Canada–gets her medications at no charge? And non-senior Canadians pay far less than we do for drugs manufactured in the US–while the cost of both my Medicare D policy and my drugs are going up considerably next week, in 2010.
So when I hear that the health care “reform” bills aren’t perfect, but are just a beginning, I have an overwhelming sense of deja vu.
Why is it they just don’t get it???
they do get it ………health care ………. we don’t …
if they didn’t get it …….. health care ….. we would …
…. cute btma ……
Well, the Canadian gov’t has a very large risk pool to bargain with because it includes all their citizens. The U.S. gov’t, by contrast, has sweetheart deals with big Pharma and risk pools that are splintered by the number of insurance companies doing whatever bargaining there is to do. Furthermore, my understanding is that if the Canadian gov’t is caught allowing U.S. citizens to buy drugs at their discounted rates, big Pharma has threatened to raise their rates.
Here is a quote from an email a friend sent me. She is also very progressive, and we were trading comments on the HCR stuff. My bold.
Ann,
I always enjoy your diaries; when you get riled, you make your case with focused clarity. This is no exception.
So sorry you are entering the bizarro world of the donut hole.
Anyone know how the donut hole came to be? Seems diabolical to me, but I don’t know the background.
(((Ann)))
I read that the claim was they had to create the donut hole in order to be able to afford the prescription drug benefit program at all. I have no idea how they expect people who are on Medicare, or living on Disability to be able to come out of pocket with $3,000-$4000 for necessary drugs when many make less than $25,000 a year. In other words, if the government can’t afford it, how the hell can I? But insanity prevails.
If a final version of HCR passes it will undoubtedly include Eshoo’s evergreening amendment but I will not be surprised if plans to close the doughnut hole (ever) will be scrapped.
Net gain to health care consumers, zero.
They truly have Americans boxed in and we have to do something about it. If we allow the walls to keep closing in, we will all be living in poverty and dying too soon.
Yes, Twain. That is exactly why I am actively hunting for a place to live in another country. The US has become a giant machine for plundering the last few holdings of the middle class. Thailand, Mexico, parts of France, eastern Europe. They are all in the running. I have to give up my dog, what little family I have left and friends. But what’s the alternative? Serfdom.
Well one alternative would be to put up a good fight here at home and take advantage of the freedom and rights you still have.
If the fight is lost then yeah the hell with this place. This whole scheme of bastardized so called free market ideology is pathetic and rigged and predatory. Other countries have long since figured out ways of living peacefully and assuring people a decent quality of life.
But given the good features that are still left to us in this country we should engage the fight. And it a poor measure of the people that they are not willing or even contemplating the need to fight.
Boldly defending one’s right to a decent existence is risky in this country. The minute you call or take part in actions outside the narrow confines you are permitted to act in, such as engaging in boycots or non-compliance with oppressive laws and mandates, then the yammering clas will call you radical and extreme and a spoiler of the Democratic party and of being a Naderite.
As if anybody gave a shit for the Democrats or Obama. The very point of undertaking these measures is to take actions that are directed against what Obama and the Democrats have foisted on us. They are exactly the people we are dissatisfied with and acting against.
Now, now. It’s your patriotic duty to go without so that the government can fix its deficit problems. We can’t have the difference come from wars and bank bailouts because those are really important for this country. People? Not so much. Either find enough money to make some huge campaign donations or have the decency to die before you cost the poor government any money. And don’t forget to absentee vote Democratic in the meantime in case you’re too sick to make it to the polls. Because they are working hard for the people and really care about the little guy.
Thanks Ann – recommended. Ann from what I have read you and many seniors will get no relief for several years and then only gradually… WTF How does that help some one who is currently struggling between food, rent and the life sustaining Drugs they need. This is just the Republican way to get rid of more Voters! As we know with fewer voters the Republicans have a better chance of winning elections. The majority of them could care less about our seniors or for that matter if you aren’t with them you are against them thus expendable and don’t need no freaking Drugs!
This Bill is a POS and unless radically changed it should be killed.
Kill The Bill Baby Kill The Fucking Bill
I was warned by friends to not get into Part D so I didn’t. I did, however, reach the max my insurance company would pay for meds on Oct. 1 and have now been paying myself until Jan. 1. It’s really expensive.
Medicare Part D requires you to enroll in a private insurance plan. Chances are you would have come out more or less the same.
If you want to check, there is an applet available at the Medicare home page that lets you enter the prescriptions you use and then quickly compares insurance plans available and tells you what your annual out of pocket expense would be with each. I’ll try to post a link in a couple minutes.
Here is the link, just click the “Find and compare plans” button.
Thanks. I’ll use it.
I’ve commented in the past that Medicare Part D was a rehearsal and the current HCR debacle is the full production.
It only just struck me how apt that really is, Medicare Part D mandated that seniors and others with Medicare purchase a drug plan from a private insurance company OR face a penalty if they choose to enroll later.
I have decided that the members of Congress are pure scum, with very few exceptions. It saddens me that I no longer believe anything that a politician says. Didn’t used to be that way.
Democrats used to believe it was necessary to actually produce something tangible occasionally to show to voters they deserved to be in office. For the past 20 years though it’s been a complete sham. They spout some populist rhetoric at election time but never actually do anything for the common good.
Wow. And that was NEVER brought up during this evil process.
That’s not true. It was an option, not a mandate. It is true that if you didn’t enroll in the first year your initial premiums would be more.
Well here’s a little beauty of a quote from the Medicare and You 2010 book:
Nothing like the gov’t putting a gun to your head and threatening “Make a Decision immediately, or else!” Wonder what that’s all about?
It is about putting as many hurdles in front of as many people as possible.
That must be right; I can think of no other excuse for such a statement.
That was always the case from the moment Part D was created. IIRC it was in 2005 seniors were under pressure to pick a private prescription drug plan by January 1, 2006 or be penalized. There were dozens of private insurance options available and comparison was damn near impossible.
My mom was totally stressed. Fortunately I found that applet at the Medicare website that let us enter her prescriptions and quickly compare plans and out of pocket expenses. It must have been really terrible for a lot of seniors who didn’t have somebody to help them.
The part that always blows my mind is how you keep hearing on TV and other media how much the public loves Medicare. Yet few people seem aware that Medicare only covers 80%. That’s why I determined right away I would need a Medicare Advantage Plan.
First of all, we went thru this with my mother. I remember discussing with my sister whether she would be better off with some sort of supplemental insurance due to the high cost of her medical bills. She lived with my sister at the time, and she told me it would cost $60, but she felt it would be cost effective to buy the insurance, which I agreed. Oddly, due to some new gov’t regulation or finding, a few months later the bill went down to $20/mo, and IIRC, ultimately she didn’t have to pay a monthly premium at all.
But I learned during my waiting period subsequent to filing an application for Disability just how tenuous things can be when I ended up in the hospital and they refused to release me until I had a quadruple heart bypass. (My real problem is COPD and loss of lung function.) So I never had any doubts that I needed a supplemental policy of some sort. Medicare Advantage seems to me to be cheaper and better in the long run, so that’s what I meant with.
I’ve had an Advantage plan from the outset and they just raised my premium $45. Also, my drug copays are going up on January 1st. Medicaid had been paying my premium and drug copays but the modest amount of money I inherited from my mother now makes me ineligible, despite the fact that my sole income is about $1,100 per month in SS. Apparently we are expected to burn through our savings accounts before we’re eligible.
Hello Ann in AZ,
About COPD and medications to treat it, the Boehringer-Ingelheim Corporation will provide certain drugs free (Spiriva and Combivent) to lower-income people. My significant other has this problem and we were ordering from Canada during the two year wait (after SS Disability approval). The doctor provided a form from Boehringer and I sent it to them; several weeks later, he (my sig. other) received, at the doctor’s office, nearly $800 worth of meds to last three months.
Here’s a link to their patient assistance program:
http://us.boehringer-ingelheim.com/about-us/philanthropy/patient-assist.html
Yeah, I knew that there are some companies, quite a few, really, that will help you out with drugs, but I thought you had to go by the programs of each drug that you need. For instance, Glaxo-Smith-Cline makes Advair, so I thought I needed to go thru them. The other thing is, they all seem to use your gross income, not net, and not even net of all drugs. Problem is, most of them say your gross income must be under the poverty line in order to get their assistance. I always seem to manage to be just about $100/mo over their limits. And the other thing is that my drugs cost between $760-$800/mo out of pocket if I were not on Part D or when I’m in the donut hole, if I were unable to finagle other ways of getting the meds. Thank goodness I’m still pretty inventive. Thanks for your input though. Maybe I can work on checking out that company more specifically.
B or D? I thought B (hospitalization) was always mandatory. Been awhile since I had to think about it.
Part A is hospitalization; Part B is medical insurance; Part C is Medicare Advantage Plans; Part D is Prescription drugs, and most (or at least many) Medicare Advantage Plans include Part D. Part A is paid for with the payroll taxes during all the years you worked and they withheld Soc. Sec. taxes from your check. Part B is paid for by a monthly premium withheld from your monthly SS or disability check. Part C &/or D may have a monthly premium or may not depending on which plan you choose. Mine had no monthly premium until this year. But they raised the rates, so they wanted a $36/mo premium, and my hospital copay went way up (basically, it doubled). Hence, my reason for switching to another insurance plan. It remains to be seen whether this will be a good move or not. Here goes nothing; wish me luck. Should be an interesting ride.
Thanks for the info, can’t imagine why I have trouble keeping them straight, not like it’s needlessly confusing or anything.
Good luck. :-)
“A” is hospital. “B” is doctors and tests. “D” is drugs. There are premiums for both B & D.
A is hospitalization, it’s free, and you are automatically in it. B is everything else and you have to enroll and pay.
I have been surprised at how little attention has been given to the fact that the funding of virtually the entire bill rests on Medicare cuts and changes.
As far as I can tell employer based private insurance will change much less than what is in store for Medicare. But reading the nuanced language in various reports it is obvious the intent is primarily to cut utilization and services for all.
Expect to be bumping into this more “nuanced” rendition of the bill over and over and again.
I agree with this critique in addition to all those similar ones that have preceded it. I tink that without much doubt all here realize the nature of the problem and where the blame lies.
But what I also see is the need to place a requirement on everyone who makes a critique that they in addition offer a solution that does not involve pleading with those responsible for creating the problem to please change their way.
Specifically I am insiting that solutions be put forth that exclude politicians, and the health care industry. This leaves solultions that the public can initiate on their own. Solutions such as boycots, withholding of funds, recall elections, seeking court rulings that ban mandates, and the like.
We have heard more than enough of the rationale for change, I think we all get that and have for quite a while. The question before us is, what do we do now collectively to stop the onslaught that is facing the public as a result of this pending legislation, that does not involve petitioning and pleading with the same government that will inevitably pass this legislation.
If there is not a single proposition about what actions the public can engage in then we are in big trouble. We are admitting that people in this country are powerless to thwart the will of a determined few bent on pillaging the people. Such an admission leaves little wonder as to why that pillaging takes place.
Review this post and all these comments and you will find that not a single proposed solution involving collective action is put forth. Are people here so afraid to take matters into theri ownhands?
Not exactly collective action, but when I apply for Medicare (I’m eliglble now, but still working and have health insurance through my employer) I am not going to apply for Part D. I am ‘on’ some prescription meds, but they are available as generics.
Since the government cannot negotiate the prices of meds furnished through Medicare Part D, how about a movement that encourages prople to skip Part D when they become Medicare eligible, and, to show that we are serious, an ongoing fund to help folks who need expensive proprietary meds buy them. I’d contribute to that.
That would get the attention of Pharma, and those in government who enable them to raid our wealth when we are ill.
Yes, this is just exactly the sort of collective non-compliance with punitive provisions that are meant to guarantee profits to drug makers that are bound to have an effect. It is these sorts of actions which de-fund insurers and drug makers that are called for.
Another strategy would be to just obtain drugs from overseas and Canada assuring ourselves of their efficacy and safety. And to do that on a large scale. I am sure those countries will be happhy with our business and we will defund Phrma at the same time. We need to exert our rights as consumers, if that is the role we are forced to play.
By aquiescing to all these onerous provisions that are handed down by the government like dictates to punish people as if we are serfs that need to pay tributes to overlords is demeaning and servile. We basically just have to say no we will not comply.
We should be engaging in debating and developing ways to undermine the most egregious and predatory provisions in this HCR debacle, such as forced mandates to profit insurers, this is an outrage.
In my opinion we see here an overabundance of instances that cry out for collective unified remedies and yet see precious little demand for debate as to what effective collective actions we can undertake now, to obtain the remedies we need.
Hey, especially in old age, what’s the worst that can happen? They toss you in jail. In Calif. that means prompt, free medical attention and free access to medication. This is no joke. As a traveling health care professional I worked for 3 months in a CA state prison. People actually DO commit crimes to get thrown in jail to receive medical treatment. They’ll tell you all about it! It’s like the seniors’ equivalent to young prople left with no alternative but to join the armed forces to get medical care for their family. What a country!!!
IMO, I agree with many of your suggestions. Here’s what I wrote about the health care situation just a few days ago in my Ignorance Is Bliss post:
As to the methods, boycotts are not an option for me. I will not be walking away from my insurance company or withholding funds from them or the Federal government. I need medical care and drugs and the Fed. gov’t and the insurance companies are the only means I have to pay for them currently.
However, as to recall elections or other citizen options that we’ve learned about in grade school, oh, yeah, I would consider such actions if they are well planned and executed in the right way. Let’s see, there’s the initiative, recall and referendum. And I thoroughly expect to see legal challenges to federal mandating of citizens purchasing insurance from private insurance companies.
There’s one other method that I haven’t seen you mention that might also work, whether it’s called civil disobedience or passive resistence. I remember when Obama castigated the CEOs of the 13 largest bank. ABC news reported that they sat around a table with no frills, not even ice, just water and a glass for each. Then, as the CEOs tried to state their case of rationalization for their high flying ways, he reportedly exhorted them with these words:
We need to let the Obama Administration know that if they are not part of the solution, then they are part of the problem.
We’ve all seen the pictures coming out of Iran due to corruption in their government. They are horrible, and I’m not advocating their extremes. We went through that in the Kent State incident. But it seems to me we do need to be more visible and in greater numbers. Somehow we should be following Jane’s lead. We need to somehow get to the point of calling a truce with the moderates/centrists who are reasonable enough to accept that there is a difference between the loyal opposition and enemies. Only people who can accept rivalry without rancor need apply and that includes our side. For the greater good, we need to put aside the vitriol and seek,if not allies, at least common cause.
Well, this is the start of the very dialogue I had in mind.
The task should begin now to seek actions that make sense and are likely to succeed if carried out in large numbers. Some of which may just involve non-compliance with unpopular punitive measures that the government in collusion with health companies mandates for the very purpose of enriching those companies. Such bald faced collusion is intolerable and dangerous to our system of freedom. It can not be abided and needs to be fought directly and forcefully.
My point is that people should not tolerate the government acting against our well being in that way and if it insists in doing so, it should be defied. And if the people do not defy the government it will not change on its own.
Recalls, hold promise but then why not begin the campaign to install and use them across the country for the next election cycle now?
A move to buy any medication which is currently paid for out of pocket or with a co-pay if cheaper, ought to be bought from outside the US, in large numbers. And the intention to do that should be agreed to by large numbers of people.
Mandates to purchase insurance should be defied by those people whose health permits them to do so. And again a petition should be presented to Congress with sufficient signatures stating that people will not abide by this madate and to state the reason why. Defiance to unpopular laws from the government must be face with popular opposition and not by meek submission.
There may be more collective actions that show the government not only our defiance but which can succeed in protecting ourselves against the damage that our government seems bent on imposing on us. It is justified and rational that we protect oursleves by acting on our own behalf.
This onslaught against the public for the sake of Banks and Insurers and Phrma will only continue if we don’t muster up the courage to fight. Playing nice and plotting endless coalitions is great but alone it won’t get the job done.
We need to get control of our affairs back into our owh hands.
So the doughnut hole will be slightly larger for a bit but then gradually disappear after that. Why is this a big deal? You guys are just looking for things to hate about this bill. Some of your criticisms seem a little silly.
Excellent. Well said. After working full-time since college graduation,I went on SSD over 12 years ago and waited two years for Medicare. I was able to keep my home but after paying my bills, there was never enough to pay for adequate medical care. Most Americans, especially, the White House and Congress, don’t appear to realize or care that using traditional Medicare alone is beyond the means of many, many retired and disabled people who cannot afford the high deductibles and out of pocket expenses. Many skip medications and treatment. People with higher incomes can buy Medigap insurance. What about those with lower incomes? When the Advantage and Part D plans were introduced I criticized them. I was not a Bush fan. Like many I could see that these plans were a gift to the insurance/drug companies. But, because I was desperate, I tried one. Now I see my doctor when needed and can afford tests, medications, etc. Last Spring President Obama announced that payments to Advantage plans would be gradually eliminated. He said the policies were wasteful. Insurance companies responded by cutting coverage and jacking up the prices for their 2010 plans. My plan tripled the monthy premiums and added high co-pays/fees. Donut hole coverage was completely eliminated. I needed the plan desperately and changed to a cheaper one which covers generics in the donut hole but is mostly unusable due to prices. This is a disgrace. Why can’t we improve Medicare? And why are we rewarding the insurance companies, Pharma, etc. who created this mess?
Well, of course, the Advantage plans are supposedly way overpaid/overpaying for services, but the key was supposed to be that Advantage could be cut back/out because the (sigh) public option would cover what Advantage plans cover now.
Now, of course, with pretty much, every damn halfway good thing eliminated from the bill, the cutback on Advantage – like a mandate without coverage — isn’t balanced by replacement coverage.
And the bill isn’t even “done”. The most recent outrage (to me) was hearing the other day that another Blue Dog will not vote for “any plan that establishes competition” with profitmaking insurance companies.
So, now they’re not even bothering to dissemble.