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Tilting at Windmills

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January 18, 2006
By: Kevin Drum

THE PRESCRIPTION DRUG DEBACLE....PART 341....Jon Cohn who's writing a book about the American healthcare system promises more about the Medicare prescription drug debacle shortly but wants to pass along one tidbit while we're waiting:

It's a Government Accounting Office report, issued in December, warning that the Bush administration hadn't done enough to make sure the most medically and financially vulnerable Medicare beneficiaries could actually get their drugs.

If you do get around to reading it, make sure to check out the part where Mark McClellan, director of the Center for Medicare and Medicaid Services, says the GAO has it all wrong the part where he insists that "CMS has established effective contingency plans to ensure that dual-eligible beneficiaries will be able to obtain comprehensive coverage and obtain necessary drugs beginning January 1, 2006."

You know, that sounds familiar. The Bush administration is warned that its planning is inadequate but it ignores the advice and plows ahead without listening.

Very familiar. It's on the tip of my tongue. Help me out here.

Kevin Drum 1:00 PM Permalink | Trackbacks | Comments (58)

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Comments

I want to say Katrina, because that's the obvious one, but isn't it EVERYTHING? How on earth do these people retain their aura of competence???

Posted by: Mike B. on January 18, 2006 at 1:01 PM | PERMALINK

You're doing a heckuva job Markey

Posted by: Martin on January 18, 2006 at 1:09 PM | PERMALINK

Medicare Katrina.

Posted by: gussie on January 18, 2006 at 1:10 PM | PERMALINK

Why do you hate America's seniors so much?

Yet more evidence of success of President Bush's Plan for Victory for Senior Citizens: the bile-spewing, senior-hating, left-wing blogs are engaged in another round of Bush hatred.

I'm sure those who respect all that President Bush is doing for America's seniors will pray for you.

Posted by: bleh on January 18, 2006 at 1:10 PM | PERMALINK

What debacle?

Huge Republican donors (the drug companies) get billions and billions of taxpayer dollars.

As according to plan.

Are you implying that Iraq was a debacle? Re-election and ever-increasing margins in the House and Senate, with Democrats self-castrated?

Where's the debacle? Most brilliant plan ever, for holding and expanding power...

Posted by: Gore/Obama '08 on January 18, 2006 at 1:14 PM | PERMALINK

No Corpse Left Behind.

W's domestic and foreign policies.

Posted by: t-t-t-trolls r us on January 18, 2006 at 1:15 PM | PERMALINK

Mark McClellan, director of the Center for Medicare and Medicaid Services, says the GAO has it all wrong

and anyway the GAO never earned those medals.

Same filth, different day.
.

Posted by: Grand Moff Texan on January 18, 2006 at 1:18 PM | PERMALINK

Is Mark McClellan part of the evidently huge clan that runs around making excuses for Bush and creating political traffic wrecks? That family is like a Volkswagen full of clowns.

Posted by: shortstop on January 18, 2006 at 1:18 PM | PERMALINK

Iraq? Katrina? Global warming? Wetlands destruction? Too-easy credit? Lack of energy-independence?

Hell, I could be here all day...

Posted by: scott on January 18, 2006 at 1:21 PM | PERMALINK

Maybe we need a telethon to raise money for seniors' health care. The highlight would be when Chubby Checker comes on and says, "George Bush doesn't care about old people."

Posted by: Mr Poon on January 18, 2006 at 1:21 PM | PERMALINK

There's only one appropriate course of bold, decisive action, and that's to start firing some of those GAO motherfuckers so we don't get any more of those warnings.

Posted by: norbizness on January 18, 2006 at 1:23 PM | PERMALINK

Scott McClellan and Mark McClellan are brothers. Both appear to have been dropped on their heads as infants.

Posted by: Bud on January 18, 2006 at 1:25 PM | PERMALINK

Iraq, North Korea, Katrina/Rite, Iran...any of these ring a bell, Kevin?

Hmmm, thats a tough one. I'll keep pondering.

Posted by: the fake Fake Al on January 18, 2006 at 1:25 PM | PERMALINK

It is inconceivable to call this legislation in the public interest. This legislation was a farce as soon as the provision was inserted that FORBID the government from pooling its purchasing power to get cheaper prices for consumers.

Goes to show you who's interest the law was really written for.

And once the administration was outed for hiding its 500+ billion dollar price tag, Congress should have yanked it from the floor and stuffed it up Bush's a**.

Posted by: Jon Karak on January 18, 2006 at 1:26 PM | PERMALINK

Well, maybe it's true that they have "established" effective contingency plans.

Maybe they just can't be bothered to implement them, because, you know, who gives a fuck about people who need assistance? The purpose of government is to make rich donors richer, right?

Posted by: craigie on January 18, 2006 at 1:26 PM | PERMALINK

Here's a hint -- everything they've ever done.

Posted by: dp on January 18, 2006 at 1:26 PM | PERMALINK

Ah, c'mon. Be fair about Iraq.

W did stop Saddam from acquiring yellowcake from Niger!

Thankless twits.

Posted by: t-t-t-trolls r us on January 18, 2006 at 1:29 PM | PERMALINK

The program will collapse for a simple reason- it was too big a solution to a problem. A simpler program focused on buying needed drugs for those who could not afford them would have been far superior to this monstrosity that attempts to give pretty much an equal benefit to all seniors. No one has yet explained to me what problem required that every senior be covered by a government subsidy.

Posted by: Yancey Ward on January 18, 2006 at 1:29 PM | PERMALINK

shotstop-what did a volkswagon full of clowns ever do to you anyway that you'd make such an unflattering comparison?

Cue: Al to tell us whqt bleh just told us.

Cue: someone, anyone, to tell us that Kevin must be a Republican because he didn't spell out what this is supposed to remind us of.

Posted by: URK on January 18, 2006 at 1:31 PM | PERMALINK

URK, ha! And cue Yancey, when someone answers his plea and explains something (anything) to him, to yell, "I don't believe it! I'm not buying it! Ew....get those facts away from me!"

Posted by: shortstop on January 18, 2006 at 1:36 PM | PERMALINK

it was planned sooo well.....

that various states have had to step in to prevent seniors from losing their prescriptions for a time as they transition....

because of that....

i had a talk with the head of a group that represents pharmacists....

she told me.....phasing this in would have been much better...

...and no...

her name isn't shinseki....

Posted by: thisspaceavailable on January 18, 2006 at 1:38 PM | PERMALINK

Oh, my Lord! Got off my keister and looked it up, and Mark McClellan IS Scott McClellan's brother and, presumably, Carol Keeton McClellan's son! You can't make this stuff up!

They come from fine stock all around. Turns out their dad, Barr McClellan, wrote Blood, Money and Power: How LBJ Killed JFK.

I can't stop laughing.

Posted by: shortstop on January 18, 2006 at 1:45 PM | PERMALINK

Strayhorn. Carole Keeton Strayhorn, not McClellan.

Posted by: shortstop on January 18, 2006 at 1:48 PM | PERMALINK

"a Volkswagen full of clowns."

brrrrrrrrrrrrrrrilliant.

Posted by: Donkey_Punch on January 18, 2006 at 1:51 PM | PERMALINK

This Medicare Debacle has huge potential for the Democrats - because it ties together so many points neatly.

First, it affects many politically active Americans.

Second, because it's directly tied to a corrupt system. Lobbyists wrote this thing - Congress just signed off.

Third, because it drives right into the larger issue of health care.

Fourth, because of the management angle - people can pretty easily understand why such a complicated system won't work (BTW - just the way a lot of Americans recoiled from the needless complexity of the Clinton health care plan.)

And yes, although 'competence' doesn't sound sexy, that too is a good message - The Democrats can promise only to confirm people who have a semblance of understanding in the selected field.

Posted by: Samuel Knight on January 18, 2006 at 1:51 PM | PERMALINK

From my web log entry here, I can't tell who benefitted from this program:

Medicare deadline - there's an inspirational phrase

I'm sure you'll all be glad to know that I signed up for my Medicare drug benefit like a sheep going to shearing, not because I thought I needed it, but because of a paranoid fear that if I didn't sign something now, before the first deadline, I wouldn't be any further along in understanding by the time of the second deadline, and who knows if there's a third deadline?

End result?

I was paying $420 a year to the pharmacy for the one prescription drug I take.

I now pay $320 a year to an insurance company (one of 67 screaming for my baksheesh) and approximately another $100 co-pay to the pharmacy.

I'm still taking only one prescription drug and I'm pretty sure I'm equally screwed whether I signed up or not. I won't find out until I get another prescription, I guess.

Posted by: Tom Parmenter on January 18, 2006 at 1:51 PM | PERMALINK

Iraq, Katrina, Medicare Part D, you name it - these guys routinely run the big-ass stop signs that say, "you're headed for a clusterfuck."

Which reminds me: the Iranian nukes question again comes back to Iraq. Sure, the Dems (if ever in power) have to figure out what to do about Iran. But the main thing right now is that the quality of the available choices on Iran has gone into the toilet on account of Iraq.

If Bush's objective had really been to shut down Saddam's WMD programs, he would have said in March 2003, "OK, Saddam, now that I'm sure you have no WMDs *now*, I'll get my troops out of your backyard, if you agree that the UN inspectors continue to get unfettered access."

Having won that deal from Iraq, and having showed we meant business, we would have been in an excellent position to take on the real menace next door in Iran.

But it was never about WMDs (no telling what it was about, until that day when we can inject Bush with sodium pentothal), and now we've got very limited leverage against Iran.

And for some reason the Dems get all this flak for being weak on national security issues. Go figure.

Posted by: RT on January 18, 2006 at 1:53 PM | PERMALINK

This Medicare Debacle has huge potential for the Democrats - because it ties together so many points neatly.

First, it affects many politically active Americans.

Second, because it's directly tied to a corrupt system. Lobbyists wrote this thing - Congress just signed off.

Third, because it drives right into the larger issue of health care.

Fourth, because of the management angle - people can pretty easily understand why such a complicated system won't work (BTW - just the way a lot of Americans recoiled from the needless complexity of the Clinton health care plan.)

And yes, although 'competence' doesn't sound sexy, that too is a good message - The Democrats can promise only to confirm people who have a semblance of understanding in the selected field.

Posted by: Samuel Knight on January 18, 2006 at 1:55 PM | PERMALINK

Steal a page out of Newt Gingrich's book. Newt prepended the word "Policy" with the words "failed, liberal " whenever he wanted.

So it's not the Republican party. It's the corrupt Republican party. Use it every time.

Posted by: OwnedByTwoCats on January 18, 2006 at 2:02 PM | PERMALINK

It's the corrupt Republican party.

You forgot incompetent.

Posted by: craigie on January 18, 2006 at 2:22 PM | PERMALINK

Markie? You're doin a heck of a job.

Posted by: ppGaz on January 18, 2006 at 2:24 PM | PERMALINK

Well, shortstop, I am still waiting. I will repeat the question. If the problem was that some seniors couldn't afford the medications they needed, why not construct a plan to subsidize those seniors specifically, and let those who could afford the medications continue to pay for themselves?

Posted by: Yancey Ward on January 18, 2006 at 2:32 PM | PERMALINK

But, but you said Bush's plan was "liberal" program Kevin.

And you know the Dems DID vote to okay this corporate slush fund for the pharmaceutical lobbyiest without even batting an eye - this isn't just Bush's bill - the Dems voted for it too.

And to this day the "liberal" press is coolly indifferent to whomever threatened the Medicare Chief with his job if he ever told congress what the REAL cost of Bush's pharamceutical slush fund would really cost the US taxpayer and Bush was certainly indifferent to someone being threatened and happily signed the bill after the little fact became known too - you know whow "conservative" Bush is with the biggest growing deficit of all time, in all of US history - it cost alot to give to big Pharma, and big oil - AND how very little this corporate "entitlement" program does for actually elder American citizens BUT those same citizens DID vote for Bush in overwhelming numbers.

It's what ever senior citizens really wanted to do - give hard earned taxpayer money as an "entitlement" program to corporations instead of themselves. They keep doing that, veterans like Bush no matter how much he cuts their funds.

Bush only has ONE constituency and that IS corporte American and not anyone else conservative minded or otherwise. Now Bush is jetting around the US telling senior citizens how great his corporate entitlement program is - and that would be for the corportion of course, it certianly isn't good for senior citizens, but it was never intended to be good for seniors. It Bush can't steal their SS money - maybe they,ll die early so Bush doesn't have pay them what he owes them. More left over for Bush's corporate "entitlement" programs.

I said it before, I'll say it again - Bush is not a conservative - and Bush really isn't simply a whitecollar criminal either - he just like Abramoff - Bush is a mobster, he's Mafia.

But then again, maybe there is no distinction between organized criminal behavior and new and uglier conservative politicians anymore - that IS the new GOP. The GOP and the Bush administration appear to be one and same thing as what Abramoff was, a backdoor, under the table, unethical, illegal slush fund giver to corporation who first pay Bush for the favor.

And the press hasn't got one single problem with helping Bush lie repeately to American citizens- if fact the press has even taken payments to help Bush misrepresent facts.

It's amazing that Kevin insist the press is doing its job these days and needs a sheild law.

Frankly, I think we need more journalist to do jail time. Judith Miller deserved every day she was in jail that WMD liar got - be nice to see Woodard and Keller do some jail time too.

Posted by: Cheryl on January 18, 2006 at 2:35 PM | PERMALINK

My Dad's plan D just reached it's donut hole! We're going to celebrate with homemade donut holes (if he can keep them down).

Being that we knew precisely which drugs my Dad would be on and his drugs will reach the catastrophic coverage phase of the plan (if he survives a few more weeks) -- we might get a pretty good deal from the government. However, the plan is not user friendly and was most definitely not ready to go on January 1st. I would not want to be a pharmacist right now stuck between the public and the beaurocracy. And . . . if I was healthy and poor I have absolutely no idea which plan I'd want to limit my future healthcare by.

Posted by: B on January 18, 2006 at 2:35 PM | PERMALINK

after reading tom parmenter from above....


the program is not a freebie...

its an insurance program....which requires premiums....but where they get you is....

you must sign up now....

whether you need it or not...

obviously if you need it...that explains itself..

but if you dont need it currently...and dont sign up now...

there are heavy penalties...

i imagine most who sign up are like tom....those that dont need it...and...may never need it...

but he signed up....on the chance he wont get sick enough or depending on circumstances, poor enough...to use it....

Posted by: thisspaceavailable on January 18, 2006 at 2:44 PM | PERMALINK

inadequate planning, not listening to advice ?

check out this article by Larry C Johnson about Jerry Bremer

Posted by: cleek on January 18, 2006 at 3:13 PM | PERMALINK

Scott McClellan and Mark McClellan are brothers. Both appear to have been dropped on their heads as infants.

That reminds me of one of my favorite lines from Donne:

The world did in its cradle take a fall,
And turned her brains, and took a general maim,
Wronging each joint of the universal frame.

Posted by: Jeffrey Davis on January 18, 2006 at 3:32 PM | PERMALINK

Yes, Shortstop, we are all waiting - Why not have a plan that would allow the government to negotiate for lower drug costs? Why not have a plan that is not written by the Pharmas? Why not have a plan that is not designed to destroy Medicare and Medicaid? Why not have a plan that is not designed to pour tons of money back into the pockets of the Repug Whores in Congress and the RNC? - But remember, Oh Great Defender of the Middle Infield, all plans have to be written in a manner which will appease those wonderful Libertarian Humanitarians who are obsessed with obesity and their beloved pocketbooks. Probably worried that one bad relationship and it is back to Godiva en masse. CHOCOLATE anyone?

Posted by: stupid git on January 18, 2006 at 3:46 PM | PERMALINK

stupid git,

Was that supposed to be an answer to my question? Or was it what it appeared to be, a snide non-answer? I will repeat the question since you seem not to have understood it. If the problem was that some seniors could not afford the medicines they needed, why not construct a plan that subsidized those seniors specifically? Why construct any plan to tries to subsidize all seniors?

Posted by: Yancey Ward on January 18, 2006 at 3:51 PM | PERMALINK

I am saying why the original plan was conceived. The Democratic Party can not change this plan and health care until we retake Congress. Then we can abolish this payoff to the Pharmas - At that juncture, we can discuss changes. There were several Democratic members who voted for this bill, simply because they felt it was better than nothing for the elderly poor. This group of the poor must be protected.
This current system is designed to force people into the private sector, where the well off would be anyway. The system for the poor will fail and the right will shout "See, government handouts don't work" and Medicare will crash.

Why are you asking us about "subsidizing all seniors"? Why didn't you demand responses from Billy Tauzin when he pushed this system and now is the chief lobbyist for the Pharmas? Why did you not demand answers from Tom DeLay when he kept the vote open all night? Why are you so obsessed about paying for obese people to be on government healthcare? Does it offend your aestheticism and/or your pocketbook?

Posted by: stupid git on January 18, 2006 at 4:31 PM | PERMALINK

From the post

First, we raise congressional pay big time. Pay 'em what we pay the president: $400,000....In return, we get a simple piece of legislation that says members of Congress cannot take anything of value from anyone other than a family member. No lunches, no taxi rides. No charter flights. No golf games. No ski trips. No nothing.

This is terribly naive. Even if you could get legislation like this passed, it would never be enforced. Window-dressing.

Posted by: raj on January 18, 2006 at 4:39 PM | PERMALINK

If the problem was that some seniors could not afford the medicines they needed, why not construct a plan that subsidized those seniors specifically? Why construct any plan to tries to subsidize all seniors?

Why ask us? Why not ask Bush and the Republican Congress which crafted this plan? After all, it was the Republicans and their free-spending big government ways who seemed to feel this plan was necessary and wrote it into law.

Posted by: Stefan on January 18, 2006 at 4:47 PM | PERMALINK

As embarrassing as it is to admit, it looks like Mark McClellan is a graduate of the same program I am in. That is depressing. Maybe I could start a drive to strip him of his degree for bringing (more) shame on my academic institutions.

Posted by: reader on January 18, 2006 at 4:53 PM | PERMALINK

Eh, several of my former classmates are in the Bush administration. I take solace in the fact that no matter how much harm they do the country now, I will always have photos of them drunk, shirtlesss and french-kissing each other....

Posted by: Stefan on January 18, 2006 at 4:58 PM | PERMALINK

Yep, by Bush standard, it's called being fearless, having conviction, having big d*** (no brain, just big p***), a man of character, a man to be trusted by masses of cult-following, southern-slurring, white born-again christian, or any man without an ounce of reasoning capability people.

Posted by: eq on January 18, 2006 at 4:58 PM | PERMALINK

stupid git,

Most Democrats want to create a universal plan that covers all seniors as well, they just want to do it in a different way. The question is a bit rhetorical since I know that politicians are trying to buy the senior vote in one bloc, but I don't see enough people here questioning the logic of a universal benefit when a smaller, targeted plan would be far less expensive.

Posted by: Yancey Ward on January 18, 2006 at 4:59 PM | PERMALINK

but I don't see enough people here questioning the logic of a universal benefit when a smaller, targeted plan would be far less expensive.
Posted by: Yancey Ward

on what do you base that assumption?

Posted by: Nads on January 18, 2006 at 5:10 PM | PERMALINK

but I don't see enough people here questioning the logic of a universal benefit when a smaller, targeted plan would be far less expensive.

I'd echo Nads' question. Given that most other post-industrial countries offer insurance that both covers their entire populations and costs significiantly less than ours does, the correlation between universality and higher cost that you assume doesn't seem to be there. The most efficient solution is often to cast a wide net rather than wasting resources with constant tinkering at the margins.

Posted by: Stefan on January 18, 2006 at 5:50 PM | PERMALINK

Don't forget the failure of No Child Left Behind.
If seniors wanted Bush's attention, they'd become Pioneers and Rangers like the really important people do.

It was too big a solution to a problem. Posted by: Yancey Ward

Not when you realize that Bush thinks the real problem is not enough government subsidies are going to big Pharmaceuticals.

Posted by: Mike on January 18, 2006 at 6:11 PM | PERMALINK

Would that Government Accounting Office have anything to do with either the old General Accounting Office or the new Government Accountability Office (which are two names for the same thing) ?

Posted by: Robert Waldmann on January 18, 2006 at 6:50 PM | PERMALINK

The wife of a friend of mine here in Ohio is a psychiatric nurse who does home visits. Most of her patients are barely able to live independently.

This past weekend, three of her patients died because they could not get their medications.

Three, in one weekend.

Posted by: Frank Wilhoit on January 18, 2006 at 10:13 PM | PERMALINK

Hurricane PartDrina

Posted by: scotus on January 19, 2006 at 7:45 AM | PERMALINK

This really goes ack all the way to 9-11 when after being told that there was a disaster in New York (even before the evidence of a planned attack) our president continued to sit in a classroom listen in to "My Pet Goat." Either he was too terrified to act or more likely assumed that it was someone else's problem. His handlers didn't have a clue what to do. The people who were paid to imagine the uniagminable were already being replaced with political hacks who had no clue what to do or assumed in turn that this was someone else's problem.

This didn't start with Katrina. This disinclination to govern started the day Bush was sworn in as president.

Posted by: beb on January 19, 2006 at 8:41 AM | PERMALINK

Maybe we need a telethon to raise money for seniors' health care. The highlight would be when Chubby Checker comes on and says.

Posted by: shone on January 19, 2006 at 9:34 AM | PERMALINK

Several years ago, my state's Republican-led government created a mess somewhat like we are now seeing with this newly privatized Medicare drug plan.
A successful procedure had been in place for years whereby all child support checks were sent through county clerk offices [providing a record of payments or non-payments] then those checks were forwarded on to the recipients of child support.
Republican state office holders decided to privatize and change this process. To no one's surprise, the private company awarded this job just happened to be located in the district of the Republican leader of the state Senate. That private company would NOT be receiving, recording, and forwarding those checks, as had been done by the counties. Instead the private company was allowed to receive, record and CASH those checks, depositing them into a big central fund.... then issue a different check to the child support recipients.
As with today's mess with the privatization of Medicare drug support, the new private system created crisis, confusion and prompted intervention rescue. The vulnerable who absolutely needed those checks for food, housing and heating went over a cliff. State government jumped in to issue emergency checks to recipients in dire need. This emergency intervention cost tax-payers a ton of money beyond the checks issued. State employees were given overtime pay for what became months of evening and weekend crisis intervention work. [One of those state employees later told me he himself earned some $40,000 extra that year in overtime pay.]
What never was mentioned publically was the positioning of the private company, who had control of a huge fund [millions of dollars] with which they could earn untold windfall interest income as long as the crisis continued. Also, the public never learned whether the private politically connected company was ever required to reimburse that huge amount of tax-payer money that had been used to rescue the neediest citizens.
Remembering this privatization crisis from a few years ago, and how it just happened to benefit the private company's bottom line......I sure would like to know 1]whether the insurers under the Medicare D plan are automatically receiving federal tax-payer funds for all those recipients they cover and aren't yet serving [the part of the premium costs paid by the government, not the part paid by the recipient];
and 2] whether those insurers are able to earn interim interest on those monies;
and 3] whether the federal legislation which privatized the drug program includes a] penalties for those private insurers who mess up and harm the vulnerable and/or b] any requirement that the private insurers reimburse those state government funds being used to cover the present emergency.
I want to know answers to these questions because I want to know whether this drug program "crisis" is real [government and private incompetence], or whether it is a kind of business strategy. Remember the energy crisis in California, a crisis manipulated by Enron simply to rake in money at the public's expense?

Posted by: Donna on January 19, 2006 at 10:58 AM | PERMALINK

Stefan and Nads,

Then the problem you are trying to address wasn't that some seniors had problems paying for the medicines they needed, but that seniors as a whole were being charged too much for pharmaceuticals, whether any subsection of them actually could already afford it. However, since money is fungible, you could just as easily decide that seniors are being charged too much for everything else, and you would logically conclude that government should provide benefits for all seniors, for all these other items?

Posted by: Yancey Ward on January 19, 2006 at 2:44 PM | PERMALINK
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Posted by: 免费电影 on January 20, 2006 at 9:47 AM | PERMALINK

Hey are you guys still accepting commments here?

Posted by: Riverbelle on January 20, 2006 at 11:55 AM | PERMALINK




 

 

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