Sunday, October 07, 2007


Many of us pointed out all the flaws in the Medicare Part D drug plan rammed through the 109th Congress several years ago: the doughnut hole in coverage and the ban on government negotiations with pharmaceuticals on drug prices. The part that didn't get much attention, the complete privatization of the drug plan, is the one that currently shows the stupidity of how the plan was put together, according to an article in today's NY Times.

Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found.

The problems, described in 91 audit reports reviewed by The New York Times, include the improper termination of coverage for people with H.I.V. and AIDS, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.

Medicare officials have required insurance companies of all sizes to fix the violations by adopting “corrective action plans.” Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits.

The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.

The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications.

Medicare used to be one of the most efficiently run programs in government, much more efficient than any privately run health insurance program. Consequently, the GOP decided to change all of that by giving the new business to the for-profit insurance industry, and here is the result. People are being arbitrarily being dropped from plans they paid for, formularies are being changed midstream by the insurance companies, benefits are being denied without physician review, and no workable avenue of appeal has been developed in any of the plans.

Medicare and Health and Human Services Department leaders are spinning the problems by pointing out just how well the system works. All those audits and fines show just how effective the program is. The fact that additional taxpayer dollars were spent to catch all of those crooks apparently isn't factored into the rosy news.

What a surprise.

But then, who could have imagined?

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