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Scotty on the Hot Seat

Arianna skewers Scotty and his brother pretty good.

First, Mark, Administrator of the Centers for Medicare and Medicaid Services, rolled out the president's Medicare prescription drug program -- which, right out of the gate, is being regarded as one of this administration's biggest debacles (and that's saying something!).

And while Mark was busy fending off angry senior citizens who want their drugs, brother Scottie has had his hands full fending off angry reporters who want to learn how well the president knew Abramoff.

Keep reading. It's an "ouch" type post.

[graphic created exclusively for TalkLeft by CL.]

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    Re: Scotty on the Hot Seat (none / 0) (#1)
    by jimakaPPJ on Wed Jan 25, 2006 at 05:32:40 AM EST
    Debacle? As compared to what? No drug plan? This is pure partisan politics. I signed up in Decmember, got card, etc. and have zero problems. The cost is less than 30% of what I was paying. For those computer challenged there were seminiars, meetings, guidelines, etc., available. The question I have is this. Why didn't the Demos demonstrate their ability to do this years ago. Instead they did nothing, and now can do nothing but complaining.

    Re: Scotty on the Hot Seat (none / 0) (#2)
    by soccerdad on Wed Jan 25, 2006 at 06:51:51 AM EST
    Yes it is a debacle if only because the projected cost is not sustainable. The plan as rolled out forbad competition, leaves a big hole in coverage after initial coverage and has been a boondoogle to corporate interest. Clearly this program will be cut back. Its projected costs make SS look like chump change. And as I posted yesterday, Bush plans (in the upcoming SOU) to undercut the whole concept of health insurance with the emphasis being on HSAs which will attract primarily the healthy leaving the chronically ill, old etc with an even greater financial burden and risk.

    Re: Scotty on the Hot Seat (none / 0) (#3)
    by Talkleft Visitor on Wed Jan 25, 2006 at 07:59:20 AM EST
    Jim, I honestly am pleased for you that the new medicare plan works well for you. But for many individuals who are vulnerable physically, mentally, or financially, this has been a medical disaster. If 26 states hadn't stepped in to protect their own, things would have been far worse: State faces Medicare plan 'nightmare' Harris News Service
    ...The toll continued to rise Tuesday, with Kansas spending $1.6 million within just a week for 23,000 claims from senior citizens who began to enroll Jan. 1. Some legislators expressed skepticism that the state would recover the mounting hit on the budget. "When all of the states start saying, 'We've got to have more money,' the federal government is going to start saying, 'Well, wait a minute.' " said Kansas Senate Insurance Chairwoman Ruth Teichmann, R-Stafford. "I'm afraid they're going to start saying, 'It's your problem, you've got to take care of it,' "
    PPJ: Debacle? As compared to what? No drug plan? Maybe. One of the first rules of medicine is "Primum non nocere," first do no harm. Thousands of years of experience have taught physicians that a bad action is often worse than inaction.

    Re: Scotty on the Hot Seat (none / 0) (#4)
    by scarshapedstar on Wed Jan 25, 2006 at 09:40:37 AM EST
    Debacle? As compared to what? No drug plan?
    So what you're saying is, there's no such thing as a bad entitlement program? Who's the conservative again? ;)

    Re: Scotty on the Hot Seat (none / 0) (#5)
    by jimakaPPJ on Wed Jan 25, 2006 at 10:31:35 AM EST
    SD writes:
    The plan as rolled out forbad competition, leaves a big hole in coverage after initial coverage
    The above is absolutely false. There are about 40 companies selling the plan. Many have three, or more, types of plan to meet the various needs. Some have deductibles, some do not. Some have the "doughnut" hole, some do not. The plan I chose is $23.00 a month, has a $250. deductible, the "doughnut hole" and fairly stiff co-pays. This is based on my history of Rx use. If my needs change, I can change plans next year. For my spouse we picked a different plan. It has no deductible, covers 100% of the year - no "doughnut hole" - and low co-pays. It costs right at $70.00 per month. Her needs are different. Doubt me? Go to medicare.gov and see for yourself. As for the rest of your claims, they are just claims. And most likely as inaccurate as the specific ones I just exposed. punisher - The article you quote is about as clear as the Missouri river as it rolls through K City. First, many of the problems are caused by people on medicaid not switching/signing up for the new program. Evidently the states, and it is the states, not the Feds, who administer medicaid, did a lousy job of taking care of their medicaid clients. As a result, many drug strores are filling the critical requirements and yelling at the state to pay under the old program. That has nothing to do with the Medicare Rx program. Secondly, many people who receive Medicare waited until after Jan 1 to try and sign up. That was in spite of all kinds of media information, seminars, etc. Our local health department had about 12 seminars in October - December, plus volunteers contacted older folks and offered to help. Some help was accepted, some was not. I put this down to human nature. Some people just wait until the last minute. That will work itself out over time. (I'm just today helping an older person who admits to knowing, but just kept putting it off.) And I loved the complaint of too many choices... BTW - Prior to Jan 1, there was NO Rx insurance program. So your "do no harm" in your comment is not accurate. scar - I have never claimed to be a conservative. I invite you to prove me wrong. The Rx program is not an "entitlement." It is paid for by medicare deductions from your paycheck, just as social security is. It is further funded by payments from the individual through deductions from their Social Security checks. Those seniors on medicaid and other assistance have been folded into the program, but it is funded separately.

    Re: Scotty on the Hot Seat (none / 0) (#6)
    by Talkleft Visitor on Wed Jan 25, 2006 at 10:58:56 AM EST
    PPJ: punisher - The article you quote is about as clear as the Missouri river as it rolls through K City. What part was unclear? Unclear about what? Thanks for the beautiful metaphor, made me long for the mid-west, but re: the article, it seemed to me to make its point, that KS is paying out big bucks to protect their folks through the disorganized transition into the new system, and their concerned that they won't get it back. Anyway, if you don't like this article, just google news the word "medicare." There's so many to choose from. Here's the top hit for that search now: Senators told Medicare woes to be fixed By William L. Watts, MarketWatch Last Update: 1:17 PM ET Jan. 25, 2006
    WASHINGTON (MarketWatch) -A top Republican senator said Wednesday that he's pleased with steps taken by the Bush administration to fix snafus that have marred the implementation of the Medicare prescription drug program, leaving more than two dozen states to pick up the tab for low-income seniors.


    Re: Scotty on the Hot Seat (none / 0) (#7)
    by soccerdad on Wed Jan 25, 2006 at 11:04:37 AM EST
    PPJ let me clarify, the competition is wrt to the drugs themselves. Medicare etc are not allowed to negotiate a lower price for any drug. This is a drug plan. This is the boondoggle for the drug companies.

    Re: Scotty on the Hot Seat (none / 0) (#8)
    by jimakaPPJ on Wed Jan 25, 2006 at 01:21:41 PM EST
    punisher - My point was that if you want to assign blame, blame Kansas for not working out an orderly transfer of Medicaid, their responsibility, to the new program. Not the new program. The secondary issue is that many people just didn't pay attention until very late, and then you had a huge rush. Now you might argue that the individual companies should have had more people, they are the ones you call not the Feds. But when you do that, you argue that the Feds should determine how mant people each company must hire for various tasks. This is just a replay of the Katrina issue. People and State screwed up, blame Feds. SD - You are still wrong. The government can not, but the individual insurance companies can and do. That's why you have different prices for different plans and different companies. BTW - The argument for the government not setting prices goes back to flu vaccine and many inoculations for children. The government drove the price so low that manufacturing left the US. Result shortages.

    Re: Scotty on the Hot Seat (none / 0) (#9)
    by soccerdad on Wed Jan 25, 2006 at 01:42:09 PM EST
    The individual companies also don't have to continue to carry the drug you want and are allowed to change the price at any time despite the fact that you are required to stay with the company for 1 year. [unless this has been changed in the last couple of months] Also about 75% of those over 65 have never been online and the Govt has discouraged professionals such as Drs. from advising patients although many still do. Not allowing Govt programs to negotiate [ as oppose to set] prices is just a way of fattening up the bottom line of big pharma. note Canadian programs negotiate their prices and are generally lower than here in the US. And of course the response to this was to ban importing those drugs by individuals. The projected cost of the drug benefit over the next 10 years is somewhere between 700 and 1000 billion dollars. Simply the program will have to be altered.

    Re: Scotty on the Hot Seat (none / 0) (#10)
    by Talkleft Visitor on Wed Jan 25, 2006 at 01:49:00 PM EST
    PPJ: punisher - My point was that if you want to assign blame, blame Kansas... Ok. I hear you. But 26 states took emergent action to cover their residents. That's just the ones that decided to take action. Permit me, if you would, to get hypothetical for just a second. What if, hypothetically, that had been not 1/2 of states, but rather every state? Would we say that all the states blew it? Or might we wonder if the Feds were in some way to blame? I think that if 1/2 the states found the transition to warrant emergency action, then that's a pretty bad record that the Bush team needs to bear some responsibility for. You might argue that even if every state had found itself in an emergency situation, then its still not the Feds fault. But that would seem to me to be unreasonable.

    Re: Scotty on the Hot Seat (none / 0) (#11)
    by jimakaPPJ on Wed Jan 25, 2006 at 02:31:59 PM EST
    punisher wrote:
    Or might we wonder if the Feds were in some way to blame?
    Given that the program start date has been known for over two years, I would think that the states had ample opportunity to do the right thing. Do you believe they would have let the Feds come in and take over their programs? I mean, talk about the battle of the bureaucrats. SD wrote:
    The individual companies also don't have to continue to carry the drug you want and are allowed to change the price at any time despite the fact that you are required to stay with the company for 1 year.
    There is nothing different there than in any company plan offered to their employees. And around here, a very rural area BTW, there were all kinds of help for those who didn't have a computer, plus you could call the various companies direct with your information and get pricing. You know, like most of us did, oh say in '94 when we wanted to buy something. "AAA Motors? What's your price on a '94 Hupmobile, 4 dr, a/c, ww, automatic..luxury interior? "BBB Motors? What's your price...' You write:
    Not allowing Govt programs to negotiate
    What don't you understand that the individual insurance companies... the people who are selling the insurance to YOU, can cut any deal they want with the drug companies?? That's why you have different plans and different prices. If the government did it, it would be one size fits all. And that is Canada's plan. As for your cost estimates, who knows. Certainly not you or me.

    Re: Scotty on the Hot Seat (none / 0) (#12)
    by soccerdad on Wed Jan 25, 2006 at 02:41:46 PM EST
    The drug companies were able to insert a provision that forbids the federal government to buy drugs in bulk at a negotiated price. And by dividing the purchasing power among hundreds of insurance companies, each with far less clout than the government, they can reap higher prices for their products. The insurance companies, meanwhile, got their piece of the action. They manage the drug benefits. And because their plans can come with different premiums, deductibles and co-payments--and offer different lists of drugs, which the insurers can change--beneficiaries have no way to effectively compare the options. There's profit in confusion.
    snip
    When he pushed his plan to Congress in 2003, the number had risen to $400 billion. At the time, a government actuary had determined that the program would cost a lot more than $400 billion, but he shut up after Scully threatened his job. And so taxpayers are now looking at a $724 billion bill.
    link by allowing companies to change their drugs carried and/or prices but not allow subscribers to change clearly puts the consumer at risk.

    Re: Scotty on the Hot Seat (none / 0) (#13)
    by Sailor on Wed Jan 25, 2006 at 03:32:10 PM EST
    WASHINGTON (MarketWatch) - A top Republican senator said Wednesday that he's pleased with steps taken by the Bush administration to fix snafus that have marred the implementation of the Medicare prescription drug program, leaving more than two dozen states to pick up the tab for low-income seniors.
    even bushco knows they screwed up.

    Re: Scotty on the Hot Seat (none / 0) (#14)
    by joejoejoe on Wed Jan 25, 2006 at 04:57:59 PM EST
    Best Scottie graphic EVAH! New graphics are consistently good and lots of fun - keep up the great work.

    Re: Scotty on the Hot Seat (none / 0) (#15)
    by jimakaPPJ on Wed Jan 25, 2006 at 05:01:17 PM EST
    SD writes/quotes:
    and offer different lists of drugs, which the insurers can change--beneficiaries have no way to effectively compare the options. There's profit in confusion.
    I think the blog you linked to is mis-named. One more time. Go to the medicare.gov site and you will find an extremely detailed program that will let you play comparsion games forever. If you don't want to do it on a computer, you can get the forms from AARP, among others, fill in the blanks and manually do comparsions until your pinkies become sore. Perhaps you should do more research and rely less on blogs that you agree with politically. As for the "change" charge, I have already noted that this no different than any plan provided employees by their employer. Of course if they could make no changes, the insured would not tbe able to take advantage of lower priced generics that become available through out the year. SD, let us face facts. The Demos would do nothing to help some of our most vulnerable citizens except complain and talk about how many old people had to choose between food and medicene. Bush acted. I suggest you accept it.

    Re: Scotty on the Hot Seat (none / 0) (#16)
    by soccerdad on Wed Jan 25, 2006 at 05:17:39 PM EST
    PPJ 26 states had serious problems why dont you accept it. One more time 75% don't have access to the web and are not versed in the vageries of these choices. Why don't you provide evidence that the conclusions in the article are wrong other than you just saying so.
    SD, let us face facts. The Demos would do nothing to help some of our most vulnerable citizens except complain and talk about how many old people had to choose between food and medicene
    absolute rubbish as you know. everyone is wrong but you, gee what a surprise.

    Re: Scotty on the Hot Seat (none / 0) (#17)
    by jimakaPPJ on Wed Jan 25, 2006 at 07:35:17 PM EST
    SD writes:
    One more time 75% don't have access to the web and are not versed in the vageries of these choices.
    I carefully explained to you the various ways this is overcome. You reject them. Just remember one thing. Prior to 1/1/06 this was not a problem because they didn't have any insurance for the Left to complain about.

    Re: Scotty on the Hot Seat (none / 0) (#18)
    by Talkleft Visitor on Thu Jan 26, 2006 at 06:20:16 AM EST
    CNN/USA Today/Gallup Poll. Jan. 20-22, 2006. N=1,006 adults nationwide. MoE ± 3 (for all adults). "As you may know, a new government program began on January 1st that provides prescription drug coverage to Medicare recipients. Based on what you have read or heard, do you think that program is working or not working?" Working 27% Not Working 54% Unsure 20%


    Re: Scotty on the Hot Seat (none / 0) (#19)
    by soccerdad on Thu Jan 26, 2006 at 06:59:19 AM EST
    The empirical evidence is that lots of elderly are having problems, all your claim to the contrary. The fact that there is information available does not make it less confusing to this population segment. the fact that coverage can be changed in mid year with the consumer unable to change plans is not like most company plans despite your claims. When I go down every year to pick my medical insurance, I have a choice between a number of plans. The benefits are all laid out and are guaranteed for the year including the drug coverage. with respect to the projected 10 year cost of the drug plan the CBO's estimate has gone up yet again.
    The Congressional Budget Office on Friday said that the Medicare prescription drug benefit will cost $849 billion over the 10-year period ending in 2015, up $54 billion from the agency's January projection, the... AP/Detroit News reports. CBO's projection does not include anticipated "savings," which could make the actual cost lower than the Bush administration's cost estimate of $724 billion over 10 years, the AP/News reports (Fram, AP/Detroit News, 3/5).
    link Even if the cost is 700 billion the plan is not sustainable given the projected costs in other parts of Medicare. So this current plan was done for political advantage, in a way to maximize benefit to Big Pharma and insurance companies and will, in the end, help speed the onset of bankrupty of the federal government. Note there is no set aside money so money to pay for the drug plan must be paid out of tax revenues. Bush's plan appears to be to destroy programs such as Medicare ands SS by spending the governement into the ground by accumulating extrodinary amounts of debt.

    Re: Scotty on the Hot Seat (none / 0) (#20)
    by Talkleft Visitor on Thu Jan 26, 2006 at 07:50:52 AM EST
    Another state that "blew it." Texas casts a safety net for Medicaid With federal reimbursements guaranteed, plan fixes prescription woes for 321,000
    Texas joined more than two dozen other states Wednesday in offering a financial safety net for elderly and disabled people on Medicaid who have had trouble getting their prescriptions filled under the new Medicare drug program.


    Re: Scotty on the Hot Seat (none / 0) (#21)
    by jimakaPPJ on Thu Jan 26, 2006 at 10:32:37 AM EST
    punisher - Your link speaks to medicaid. Your poll speaks to medicare. Medicaid is state administrated. Medicare federal. If you want to blame the feds for the states failure, what other state failure should the feds take over? SD writes:
    The empirical evidence is that lots of elderly are having problems, all your claim to the contrary
    I never said that. Please be accurate. I said that the medicaid problem is a state responsibility. The huge rush on 1/1/06 to sign up for Medicare was human nature, and not enough people in the insurance companies. That the program's flexibility in service and cost does require research. All kinds of tools were and are available. As for "change," the medicare guidelines say this:
    Most plans will have a formulary, which is a list of drugs covered by the plan. This list must always meet Medicare's requirements, but it can change when plans get new information. Your plan must let you know at least 60 days before a drug you use is removed from the list or if the costs are changing.
    So, new drugs, generics for example, can be added with 60 days notice and the ones replaced removed. There is nothing different there from a private plan except the private plan doesn't have to notify you. You just find out when the co-pay goes up for the old drug. BTW - Note the "must meet Medicare requirements" statement. As for your figures, the article doesn't say, but I believe they are just that, cost projections. Now, given that the program is medicare and user funded, premimums, the real question would be, what is the difference in cost and revenues, and how will it be funded. Just remember one thing. Prior to 1/1/06 this was not a problem because they didn't have any insurance for the Left to complain about

    Re: Scotty on the Hot Seat (none / 0) (#22)
    by Talkleft Visitor on Thu Jan 26, 2006 at 10:43:19 AM EST
    PPJ: punisher - Your link speaks to medicaid. Your poll speaks to medicare. Medicaid is state administrated. Medicare federal. You're just bein' cute now. It's the medicare/medicaid dual eligibles who had the most trouble this month. PPJ: If you want to blame the feds for the states failure, what other state failure should the feds take over? That'd get us way OT.

    Re: Scotty on the Hot Seat (none / 0) (#23)
    by soccerdad on Thu Jan 26, 2006 at 11:32:50 AM EST
    Now, given that the program is medicare and user funded, premimums, the real question would be, what is the difference in cost and revenues, and how will it be funded
    do you just make this nonsense up? Simply false it is not wholly or even mostly user funded, it is an entitlement program paid for by tax revenues and premiums which also have to cover private insurance company profits. Medicare contracts with the private insurance companies as a means of providing the benefit. The cost cited by CBO is the cost to the government that must come out of the tax revenue pool. go to the heritage foundation web site if you want a conservative view.
    This list must always meet Medicare's requirements,
    all this means is that the drug must be on the accepted list. The insurance company does not have to carry it or continue to carry it if it doesn't want to.
    You just find out when the co-pay goes up for the old drug.
    again no, with regular insurance plans that i know about they cannot change the copay in midstream.

    Re: Scotty on the Hot Seat (none / 0) (#24)
    by jimakaPPJ on Thu Jan 26, 2006 at 01:14:56 PM EST
    punisher - Yes. The states are shifting their program under the medicare program. But how does that place blame on anyone but the states? Medicaid is their baby. SD writes:
    Simply false it is not wholly or even mostly user funded, it is an entitlement program paid for by tax revenues and premiums which also have to cover private insurance company profits.
    Uh, SD.... The next time you get a paycheck, you will see that it has a deduction line item for Medicare... And yes, the individual Medicare customers are also paying the individual insurance companies. My question remains. Do the numbers you post show the program cost, or the difference between the funding mentioned in the previous paragraph and the cost? That seems to be a reasonable question. They can't? I've seen it done by at least three. Actually they don't change the co-pay. They say that the non-generic, which had a copay of $60 dollars is still available for $60. The generic is now available for $5. (Hard decision there, eh?) Or, they say it is no longer in their formulary, but you may purchase it at your local pharmacy. Just remember one thing. Prior to 1/1/06 this was not a problem because they didn't have any insurance for the Left to complain about.

    Re: Scotty on the Hot Seat (none / 0) (#25)
    by soccerdad on Thu Jan 26, 2006 at 01:34:52 PM EST
    The medicare deduction from your pay check covers all of medicare not just the drug cost. $0.75 of every dollar the govt pays out for the drug benefit comes from the general tax revenue pool. its at the heritage foundation as I said there is nothing from keeping the insurance from dropping a drug in midstream even though you can't change.
    Just remember one thing. Prior to 1/1/06 this was not a problem because they didn't have any insurance for the Left to complain about.
    when one considers the amount of scamming going on and the long term cost of the program and given that the fundamental problem of funding health care has been ignored, the rethugs did not not do us any favors. I know your attitude is I got mine ok, everyone else is on their own.

    Re: Scotty on the Hot Seat (none / 0) (#26)
    by Talkleft Visitor on Thu Jan 26, 2006 at 03:32:36 PM EST
    PPJ: ...The states are shifting their program under the medicare program. But how does that place blame on anyone but the states? Because of the impossible time frame for the transition that was mandated by the federal medicare legislation.
    For example, the Jan. 1 switch in drug coverage for about 6 million low-income seniors and disabled people from Medicaid to Medicare was written into the legislation. The one-day changeover is now widely acknowledged to be the biggest source of problems. There were repeated warnings against trying to handle such a big transition so quickly. Several recommendations were put forward by experts in and out of government for alternative approaches to slow it down or provide a stronger safety net. But the one-day switch remained fixed in the design.


    Re: Scotty on the Hot Seat (none / 0) (#27)
    by jimakaPPJ on Thu Jan 26, 2006 at 08:07:27 PM EST
    punisher - The switch had months to take place. Trust me. All it takes is commands on a "scratch pad" that are activated at 1/1/06/0059... These are just excuses made by politicans. SD writes:
    I know your attitude is I got mine ok, everyone else is on their own.
    Goodwin's Law strikes again, eh? You don't know my attitude and you have no way of knowing my attitude, so please knock off such comments. And the program might have been better if the Demos had tried to help instead of fighting it. Here I was thinking the Demos were the party of the little guy. I again note that you haven't said if your numbers are the difference between cost and funding, or just cost. Since you haven't answered I take it we are talking about the former. So the question remains, how do we fund the difference. I have noted several times that we need a National Health Care plan for everyone funded by a 4% national sales tax. And yes, you can change plans if you have a demonstrated reason to do so. Withdrawal of an important drug would be one. And you again ignore the fact that the premimums paid by the insured to the companies. Now, since the Hertiage folks had no way of knowing what plans would be selected, they had no why of knowing what the plan would have to pay. What they have is speculation.

    Re: Scotty on the Hot Seat (none / 0) (#28)
    by Talkleft Visitor on Thu Jan 26, 2006 at 08:59:16 PM EST
    PPJ: punisher - The switch had months to take place. Trust me. All it takes is commands on a "scratch pad" that are activated at 1/1/06/0059... These are just excuses made by politicans. Sorry Jim, knowledgable sources disagree with you on this one. I think you're wrong here.

    Re: Scotty on the Hot Seat (none / 0) (#29)
    by jimakaPPJ on Thu Jan 26, 2006 at 09:39:38 PM EST
    punisher - Actully the changes were done the same way you do number and class of service changes on a telephone switch, which is just a big computer with specialized I/O devices. The new code is entered as the individual changes occur, over a period of time on what is called "scratch pad" memory. At some point in time the computer is told to do two things. 1. Put the new information in. 2. Hold the old information in "scratch pad" memory.. (Just in case you get a crash.) The "time for change input" on a telephone switch varies, but is typically one day. (Could be faster.) But it can be months in other applications. And the states had a lot of time pre 1/1/06. The switch over would be one second pass midnight on 12/31. Now that is a very simple view, but that's how you do it. If the states didn't do it that way, then they had a problem of their own creation.

    Re: Scotty on the Hot Seat (none / 0) (#30)
    by Talkleft Visitor on Thu Jan 26, 2006 at 09:43:03 PM EST
    I hear you, Jim. That's your story, and you're sticking to it.

    Re: Scotty on the Hot Seat (none / 0) (#31)
    by Talkleft Visitor on Thu Jan 26, 2006 at 09:44:53 PM EST
    You don't know my attitude and you have no way of knowing my attitude, so please knock off such comments. Funny, some of the folks here think that about comments like this one: Talk about not having a social life. Link You don't know my social life, you have no way of knowing my social life, so please knock off such comments.