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Technology Stocks : COMS & the Ghost of USRX w/ other STUFF -- Ignore unavailable to you. Want to Upgrade?

To: Scrapps who wrote (21382)	7/13/2001 10:17:25 PM
From: DMaA	Read Replies (1) \| Respond to of 22053

Here's the tragedy, or the comedy, or the tragicomedy in this discussion about monopoly, unfair trade and all. We are so concerned about the MSFT GNAT on our arm, we don't seem to notice a SHARK HAS US HALF WAY DOWN and is going for the rest of us: WSJ July 12, 2001 By Ruth S. King, a writer in New York. President Bush will today propose a prescription drug card for seniors as part of a major initiative to overhaul Medicare. Democrats in Congress, even those in favor of prescription drug coverage, are already voicing opposition to anything but modest change in the administration of Medicare. Neither the president nor his opponents seem inclined to address the real problem: Medicare's iron-fisted control over physicians, hospitals, patients, and supplemental insurers. In all the discussion of health-care reform you rarely read about the restraint of trade and price fixing perpetrated by the combined forces of Medicare and the purveyors of Medicare supplement insurance. Under the auspices of the Healthcare Finance Administration -- which recently changed its name to the Center for Medicare and Medicaid Services (CMMS) -- this peculiar partnership of business and government is holding doctors and seniors in a box kept locked by law. Until age 65, Americans have a semblance of choice among health plans, which are usually provided by employers. They are also free to negotiate fees with doctors who are independent of the managed care networks. At age 65, however, all Americans are automatically enrolled in Medicare. If they remain employed and have existing insurance they can defer benefits that cover non-hospital doctors' charges. But once retired they must convert all previously held private plans to Medicare supplementary insurance, commonly called "medigap." Medicare -- read government -- then becomes the primary insurer, with privately funded medigap as secondary insurance. The glossy materials that advertise medigap insurance to seniors promise to cover all costs not covered by Medicare. In reality they do no such thing. CMMS controls all reimbursement to doctors -- and basic medigap pays only 20% of those predetermined charges. More expensive plans may also pay annual deductibles for hospitals and doctors, while the most costly alternatives offer partial reimbursement for prescription drugs. Although meticulous calculation could show many seniors that they are better off keeping premiums down and shopping around for drugs, these plans look like a good deal. But the fact is that all the Medicare-supplement insurance is basically the same, give or take a few dollars, because fee schedules are controlled by CMMS. Even policies that pay physicians who do not participate in Medicare will only reimburse doctors in the amounts approved by CMMS. As primary insurer, the government has final say on doctors' fees, and their "approved charges" are almost always a fraction of the actual bill. The government also decides which procedures should be approved and how often medical screenings and lab tests are performed. These decisions are guided by actuarial considerations rather than medical necessity. Furthermore, when Medicare decides to disallow a procedure, supplementary insurers must accept the CMMS ruling and cannot pay any portion of the bill. Even when they are ultimately approved, reimbursements often fail to cover the processing costs of claims that have been resubmitted several times. Some physicians ask patients to sign a commitment to pay for procedures that Medicare may disallow, but even then doctors cannot collect their fees without submitting the bill to CMMS review. This review takes months and mountains of forms -- and if the procedure is disallowed the patient's letter of commitment has no legal force. A senior friend who is considered high risk for any major surgery recently had nerve blocks performed for pain caused by a spinal condition. Medicare disallowed payment for that medically approved and cost-effective procedure, performed by highly trained physicians in one of New York's best hospitals. Although he had purchased what his insurance broker called "the Cadillac plan," my friend's private supplementary insurance was, to paraphrase Tom Daschle, nothing more than a muffler. Even worse, his offer to pay the doctor out-of-pocket was refused on legal grounds. Physicians who participate in Medicare must accept the government-dictated fees or face a range of penalties including eviction from the panel of Medicare-approved physicians. Doctors in private practice are free to opt out of Medicare, but internists, cardiologists, pulmonologists and other specialists who treat chronic adult-onset diseases risk bankruptcy if they leave the program. Who is at fault? First, the medical profession, which has been herded by its incompetent and useless lobby into accepting these restraints. Second, senior citizens and their supposedly representative organizations such as the American Association of Retired People, who continue to stonewall efforts at real Medicare reform like means testing, higher deductibles and co-payments for doctors' visits. The third culprit is the general public. Americans need to undergo attitude adjustment with respect to medical bills. Poor people must get care and coverage. However, affluent seniors go ballistic at the prospect of actually paying a doctor or a pharmacist. There is no reason that they should not take more financial responsibility for their care. Finally, legislators deserve some of the blame. Seniors' groups are powerful in Washington but they must not be allowed to hold the nation's health system hostage, particularly when doing so goes against the interests of their members. If Medicare as it is presently constituted is allowed to control prescription drug benefits, it can be counted on to deny payment and coverage for the most specious of reasons. Enacting a patients' bill of rights is no solution -- it would only drive companies out of the health insurance business, leaving millions more Americans vulnerable to abuse by CMMS. Real reform is impossible unless the president and Congress strip CMMS bureaucrats of their power to fix prices and deny treatment in concert with private insurers. And if Mr. Bush does want real reforms, why not consider tax-deferred medical savings accounts without restraints based on the number of employees? (MSAs are currently limited to companies with fewer than 50 employees.) Why not consider making all medical expenses tax-deductible without income thresholds? Why not index benefits to income, including higher deductibles and co-payments for richer seniors? Thanks to the best health care in the world, most Americans can anticipate reaching Medicare age. But the CMMS cartel threatens to restrict that care to the wealthy, as more and more doctors choose the risks of independent practice over submission to Medicare bureaucracy. Price fixing has not benefited consumers in other industries. It won't treat our seniors now.