Song in my head: Living is easy with eyes closed..........................The Beatles

RIP Acidman...I read his suicide note Via Libby at Last One Speaks on Saturday (the post was removed) and it had such a sense of despair that I checked back today and learned he really did take his life. Shocking. Sad. Grief. Chronic pain is unbearable at times...I just wish I could have rolled him a big phattie and smoked it with him.

Alter-Abled News

It's time I update how the new Medicare part D is working out since it started this January. The first two months weren't that smooth but I amnow able to access the medications that are covered on my plan reliably. However, if you look at my access to health care. It's not much help. Here's some numbers. The State of Oregon pays my medicare premium of $88.80 a month. I am paying $51.90 a month for a supplemental medicare plan. This premium cost was reduced from $82.50. For some reason the premium was lowered and I never received an official explanation from Clear Choice, my insurance provider, but Im going with it. That's a total of $140.70 a month for health care coverage and prescription drugs; yet remember there is no dental care included.

The problem is that I can't afford to access doctors because the copayments of $15 for each visit. It's kind of like $140 a month is being paid in case something catastrophic occurs but leaves no access for preventive care. Preventive care is important for me because of my glaucoma, depression, osteoperosis and a genetic disposition for kidney failure. I am paying $9 a month for anti- depressants and migraine meds. That part is working great. There are a couple of meds I could use but they are not on my plans formulary so I would have to pay full price for them. They are for allergies and osteoperosis which I can't afford so I'm putting those issues on ignore.

Anyway, now to the problems and to some recent articles regarding Medicare and its problems.....First from the NYT...some snips of the problems with the insurance companies

• After enthusiastically promoting Medicare drug plans for three years, the Bush administration is having difficulty regulating these same plans to ensure they comply with federal standards for marketing, customer service and consumer protection.

• The new benefit is administered by dozens of private insurers under contract to Medicare, which has set detailed standards for marketing and customer service. Federal officials said many insurers had evaded their duty to resolve complaints from beneficiaries and had instead simply referred callers to the government's toll-free telephone number, 1-800-MEDICARE (1-800-6-334-2273).
  

• Under federal rules, Medicare officials can impose civil fines up to $100,000 for each violation of federal standards. In a document describing its enforcement strategy, the Bush administration said it saw no need to disclose the penalties or other sanctions that might be imposed on prescription drug plans in the future. A public listing of enforcement actions "could unfairly impede business opportunities" for insurers that later correct their deficiencies, it said.

• Federal officials issued regulations for the Medicare drug program in January 2005. Since then, they have clarified, revised and expanded the requirements by issuing hundreds of guidelines, memorandums, bulletins, fact sheets, tip sheets, instructions, "frequently asked questions" and other documents providing informal guidance to Medicare drug plans and pharmacists.

• The federal government has issued guidelines for the marketing of Medicare drug plans, but state officials say they have not been adequately enforced.Jorge Gomez, the Wisconsin insurance commissioner, who is also a spokesman for the National Association of Insurance Commissioners, said: "State regulators are very concerned about the aggressive marketing practices of certain prescription drug plans. Some brokers and agents are using Medicare Part D as a pretext to get in the doors of Medicare-eligible consumers, then selling them a variety of unrelated and sometimes unsuitable insurance products."
  

From my perspective I still see the health insurance companies benefitting from the prescription drug plan. Here's some recent Oregon Medicare health insurance market news from a Statesman's Journal article...

4 firms corner Medicare drug market

When Medicare launched prescription-drug coverage, more than 20 insurance companies jumped to get their share of business in Oregon. But a new study from an independent consulting firm shows that four companies have the bulk of the market.

ODS Health Plans, Humana, United Healthcare and Asuris Northwest Health have more than 60 percent of the market share in Oregon, says the report by HealthLeaders-InterStudy, based in Nashville, Tenn.

Two Northwest companies are among the leaders in Oregon along with two insurers that have dominated the national Medicare market.

My income is low so I don't have a gap in my prescription coverage but for those who are now paying out of pocket as they reach the gap or "donut hole" a recent NYT editorial shows an increase in drug prices that will impact consumers.

Escalating Prescription Drug Prices

Two recent surveys of drug prices by consumer advocacy groups show a disturbing pattern of increases as the new Medicare drug benefit was getting under way. The surveys make it clear that health plans and individual consumers will need to be especially vigilant to keep spending on medications within reasonable bounds.

An analysis of 193 brand-name prescription drugs by AARP, which represents older Americans, found that their average wholesale prices increased 3.9 percent over the first three months of this year, almost four times the general inflation rate. Those increases will almost certainly drive up retail prices for consumers who pay out of pocket and will result in higher insurance premiums for many of those who have drug coverage.

Indeed, the second survey, by Families USA, a patient advocacy group, found that virtually all of the new private drug plans under Medicare raised their prices for frequently used medicines between mid-November 2005, when enrollment began, to mid-April 2006. For 19 of the top 20 drugs prescribed for older Americans, these changes were virtually identical, on average, to changes in the wholesale prices charged by manufacturers.

These price trends ought to put enormous pressure on Medicare drug plans to get the steepest possible discounts and rebates from the manufacturers when negotiating drug prices for the coming year.

The Families USA study found that the Department of Veterans Affairs has negotiated much lower prices than the private drug plans were able to achieve for the top 20 drugs. If the plans can't do better, Congress should allow the Medicare program to negotiate prices directly with the pharmaceutical companies, an approach that was blocked on the theory that competition among private plans would suffice to keep drug prices down.