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APHA Scientific Session and Event Listing

Recorded presentation

Joel M. Albers, PharmD PhD, Minnesota Universal Health Care Action Network, Community-University Collaborative Research w/ University of MN, Calhoun Arts Building, Rm 502, 711 W. Lake Street, Minneapolis, MN 55408, 612-384-0973, joel@uhcan-mn.org

Medicare Part D, took effect January 1, 2006 under the guise of providing a substantial drug benefit to seniors and people with disabilities in a “consumer choice” competitive market. Instead, Part D dismantles Medicare as a public social insurance program, by contracting out to private sector HMO and Pharmacy Benefit Management Company (PBMs), oligopolies. A massive deceptive campaign to privatize, with AARP complicity, was led by President Bush, Congressional leaders, and before that, the Democrats, beginning in 1999, following a Bipartisan Medicare Commission recommendation to privatize Medicare completely, with no drug benefit. PhRMA lobbied for this but later scaled down to privatizing Part D without price controls. Ironically, The Health Insurance Association of America initially opposed underwriting the huge financial risk of a privatized Part D. Yet PhRMA's massive lobbying, campaign contributions, and deceptive advertising won out. The Medicare Modernization Act of 2003 passed only after Bush promised billions in taxpayers subsidies to insurers, HMOs, PBMs and others. The $2,489 “donut hole” in coverage and penalizing the majority of relatively healthy seniors to pay in, also pays for the corporate subsidies. This flawed design based on previously failed market models (Medigap, Medicare-HMOs Part C, and PBMs), has caused predictable confusion, disruption of pharmacy care, medication denials, and unnecessary hospitalizations. Additional provisions in Part D include individual Health Savings Accounts and HMO pilot projects to further privatize Medicare, which seek to dismantle health insurance and diminish prospects for public universal single-payer health care as a human right.

Learning Objectives: At the conclusion of this session the participant will be able to

• Identify, define and differentiate whether a proposed health care system reform model fits into the overall framework of
  • a private market-based commodity or
  • public social insurance.
  • Describe the history, economics, and politics of Medicare Part D in terms of
    How it became a "law"; revolving door and interlocking of government and corporate sectors; the power plays and players regarding lobbying, campaign contributions, advertising, and strategic alliances; who benefitted.
    • Evaluate past prescription drug benefit models that worked and didn't work as public policy, and which should and should not have been implemented in Medicare Part D.
    • Using past U.S. or other presciption drug benefit models, construct an improved and upgraded Part D drug benefit structure.
    • Discuss how the economic design of Medicare Part D accounts for the confusion, the "Donut hole", and the penalty for seniors not signing-up.
    • Recognize how the current design of Part D causes confusion and disrupts continuity of patient care and drives a wedge between the patient-practitioner relationship.
    • Given Medicare Part D's "fundamentally flawed design" and calls to "scrap it and start over", construct a new prescription drug benefit for seniors.
    • List 5 actions for building a grassroots movement to repeal and redesign Medicare Part D, and improve and expand all of Medicare into a universal health care program as a human right based on need.

    Keywords: Drugs, Health Reform

    Related Web page: www.uhcan-mn.org

    Presenting author's disclosure statement:

    Any relevant financial relationships? No
    

    Recorded presentation

    Health Care for People, Not for Profit

    The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA