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Tilting at Windmills

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June 11, 2006
By: Kevin Drum

DONUTS, NOT DONUT HOLES....In Texas, Robert Pear reports that senior citizens are finally learning about the notorious but until now mostly theoretical Medicare prescription drug donut hole:

Jose M. Flores, a Medicare beneficiary who lives outside McAllen, used the new drug benefit four times from January to April to purchase Byetta, an injectable medicine for diabetes. Each time he paid $40.

So when he went to the pharmacy on May 25, he was dismayed to be told that he owed $167.56 for the next month's supply. Mr. Flores had reached the notorious gap in Medicare's drug coverage. He had to pay the full price of Byetta. His Medicare drug plan paid nothing.

"It's almost useless," said Mr. Flores, a 66-year-old school bus mechanic who was interviewed at his home in La Joya, Tex. "I'm paying the premium, but not getting protection."

Yep, the Republican Party's Medicare prescription drug plan pays for prescription drugs until you reach a certain limit, then pays nothing, and then after a few thousand more dollars starts paying for your drugs again. And this isn't just an embarrassing mistake. It's deliberate. As Mr. Flores astutely points out, though, there's no donut hole in the premiums: you keep paying those every month regardless of whether or not Medicare is paying for your drugs. With considerable justice, this strikes most people as insane.

Democrats are generally in favor of government programs for worthy purposes like healthcare, education, and the environment, and people generally say they trust Democrats on these issues. The problem is that people lie. They trust Democrats not to randomly trash program they care about, but they don't trust them or anyone else to create new programs that don't piss away most of their funding on waste, fraud, and transparently idiotic things like donut holes and insurance industry pork. (As Pear's article suggests, but doesn't quite say, insurance company bureaucracy makes the prescription drug program far more expensive and inefficient than it needs to be.) What's worse, since the press rarely even bothers to report which party supports which stuff, Democrats probably suffer as much from Medicare's donut holes and mind-boggling complexity as Republicans.

I'm not really going anywhere with this. Just venting a bit after a week of inactivity. This is hardly a new observation or a sufficient one, but if we liberals want the public to support liberal goals, we have to convince them that we can create programs that actually work well and spend their money wisely. I'll bet Harry Reid would get more mileage out of "Donuts, not donut holes" than he does out of "Together, America can do better."

Kevin Drum 5:20 PM Permalink | Trackbacks | Comments (52)

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The senior citizens are getting something for nothing. Why is asking them to pay for a small percentage of their own medicine too much to ask? Why is it more fair to ask for me and people currently working to pay, but not them?

Posted by: American Hawk on June 11, 2006 at 5:23 PM | PERMALINK

Good to have you back. I've read speculation that the GOP created the donut hole implementation not to save money (what do they care about that?), but to convince people that government programs don't work. And indeed they don't, if they're specifically designed not to work.

Posted by: LeisureGuy on June 11, 2006 at 5:23 PM | PERMALINK

I've missed you, Hawk! A day without a wingnut is like a morning without a cuppa battery acid!

Posted by: Kevin Drum on June 11, 2006 at 5:27 PM | PERMALINK

American Hawk's brain is still broken. The elderly are not getting something for nothing: he missed the part of the post about having to pay premiums for the "coverage." Moreover, it would be different if the elderly paid the same percentage of their prescription cost every month. Instead, the coverage checks out completely after a while--and, as Kevin notes, the premiums still must be paid.

Posted by: LeisureGuy on June 11, 2006 at 5:28 PM | PERMALINK

I bet you're right Kevin. Welcome back.

And I see that AH has now reached the level of Chinese spam in its level of intelligent argument.

Posted by: craigie on June 11, 2006 at 5:28 PM | PERMALINK

Until we start talking about Health Care for Everyone then it's donut holes for everyone. As long as anyone in your family doesn't have full coverage then your family is at risk.

This business of phasing in something for the elderly, then something for the children. And leaving out the huge number of people in the middle who work for businesses that don't provide affordable health policies, STINKS.

I just don't understand why our right to health care depends on who we work for (or worked for.)

I don't understand why we support politicians who look us right in the eye and say we don't matter and our health isn't important.

For some people, the donut hole would be an improvement.

Posted by: katiebird on June 11, 2006 at 5:29 PM | PERMALINK

I've missed you, Hawk! A day without a wingnut is like a morning without a cuppa battery acid!

Missed you too Kevin. Steve is a good solid blogger, but has too many posts that don't go anywhere (see the two this morning for an example).

Leisureguy-- The premiums are a virtual formality. Their low cost doesn't come anywhere near actually paying for the medicare program. They senior citizens are paying $80 a month to get 95% of their prescription costs paid. You're right that's not quite literally something for nothing, but it's so close that it might as well be. You liberals are too literal; if I pay $10 for a house, I can say I got it for "nothing", without having to warry about people saying, "NOT TRUE YOU PAID TEN DOLLARS!!!".

If we ran the numbers, I would bet you any amount of money that he's still better off with the mediacre part d program than he would be without it. If he doesn't like the terms, he's not obligated to pay the premiums or accept the benefit.

Posted by: American Hawk on June 11, 2006 at 5:33 PM | PERMALINK

Or to vote Republican, AHawk

Posted by: troglodyte on June 11, 2006 at 5:41 PM | PERMALINK

Considering the federal government underwrote much of the research and the researchers, the actual cost of prescription drugs should be damned affordable anyway. Frankly, maybe we should nationalize most prescription drugs and make them available at cost--the entity that has to pay the most in usery and graft to Big Pharm is the government. It is a silly thing having big pharm charging whatever the market will stand on life-saving drugs. The market will stand a Hell of a lot to save the lives of the rich. Anyway, some national program is coming over the scorched panties of the GOPs--which is Dyslexic (the only language other than American they know) for SOBs.
American Hawk: if you aren't a satire, I wish you could afford your medication--it would stop the voices in your head and the gnawing paranoia.

Posted by: Sparko on June 11, 2006 at 5:43 PM | PERMALINK

C'mon Sparko They're buying the votes with your money ; they're isn't a hope in hell that the insurers ( who'd rather not pay out, thank you ) and druglords ( not really inaccurate, is it ? ) will allow a fair vote.

Posted by: opit on June 11, 2006 at 5:51 PM | PERMALINK

Sparko-- Thanks for showing true colours. Despite the liberals gnashing their teeth about imagined due process violations, you're more than willing to sieze the property of companies who-- in your opinion-- are making too much money. I seem to vaguely remember something called the "takings clause"...

Posted by: American Hawk on June 11, 2006 at 5:53 PM | PERMALINK

Why is a computer program calling itself "American" writing "colour"?

Something fishy going on...

Posted by: craigie on June 11, 2006 at 5:56 PM | PERMALINK

The R & D budget of large pharmacutical companies is larger than that of the entire NIH.

Posted by: rd on June 11, 2006 at 6:04 PM | PERMALINK

Why is a computer program calling itself "American" writing "colour"?
Something fishy going on...
Posted by: craigie

maybe its malaysian ...

Posted by: Nads on June 11, 2006 at 6:10 PM | PERMALINK

KD:
I'll bet Harry Reid would get more mileage out of "Donuts, not donut holes" than he does out of "Together, America can do better."

True, Kevin, but how about:

"Hey America!! Tired of picking up that soap yet?"

Posted by: trueblue on June 11, 2006 at 6:18 PM | PERMALINK

I'm all for "Had Enough?" as a Dem slogan for this fall. Individual candidates can provide their own lists of what they mean by that, in their speeches and commercials.

Posted by: RT on June 11, 2006 at 6:18 PM | PERMALINK

RT,

"Had Enough?" -- Is perfect.

Posted by: katiebird on June 11, 2006 at 6:23 PM | PERMALINK

The R & D budget of large pharmacutical companies is larger than that of the entire NIH.
Posted by: rd

what an odd statement. The 2005 NIH budget was $27 billion, ...

whereas, from the most recent stuff I could Google, Merck (MRK) invests $4 billion a year in R&D. Bristol-Meyers (BMY) $2.5 billion. Eli Lilly & Co. (LLY) $2.7 billion. Pfizer (PFE) $1.8 billion. Sanofi-Aventis (SNY) $10.2 billion. even combined, it's less than $27 billion.

Posted by: Nads on June 11, 2006 at 6:26 PM | PERMALINK

The R & D budget of large pharmacutical companies is larger than that of the entire NIH.
Posted by: rd

what an odd statement. The 2005 NIH budget was $27 billion, ...

Nads, the fact that rd's statement isn't technically "true" in the "the earth is round" sense isn't important. It's more true in the "santa claus is real" sense, and that's what is important. You're not against Santa Claus, are you?

It's all about truthiness, man!

Posted by: Constantine on June 11, 2006 at 6:31 PM | PERMALINK

Why is a computer program calling itself "American" writing "colour"?

Something fishy going on...

It's had a couple of slips like that. As have some of our other "American" trolls. Pretty funny, the way they all show their hands eventually.

Posted by: shortstop on June 11, 2006 at 6:37 PM | PERMALINK

I sure the hell am glad I don't need corporate America's drugs.

Hopefully I never will.

Once you let these bastards into your life...
You will be filling prescriptions forever.

I pity all those children on pychotropics.
Corporate America has got'em by the balls...

Posted by: koreyel on June 11, 2006 at 6:38 PM | PERMALINK

Why is a computer program calling itself "American" writing "colour"?

I'm American now. Doesn't mean I was born here. My only citizenship, however, is with the USA.

Posted by: American Hawk on June 11, 2006 at 6:56 PM | PERMALINK

I'm American now. Doesn't mean I was born here. My only citizenship, however, is with the USA.
Posted by: American Hawk

this does explain some of the ignorance you display here ... not all of it, but definately some.

Posted by: Nads on June 11, 2006 at 7:01 PM | PERMALINK

So, Shite Hawk is McAsshole? Or is the GOP offering 'earned citizenship through trolling'?

Anyway, a bit of corporate warfare never did anyone any harm. Just as grandma and grandma hit the hole, let's find out how much Big Pharma and Big Insurance have pocketed this year from the public purse.

And let's talk about how the GOP Congress fiddled the vote to pass the bill.

'The Republican Congress gave them the donut. Our seniors get the hole.'

Posted by: ahem on June 11, 2006 at 7:19 PM | PERMALINK

I thought it might be about now that the press and bloggers might be picking up a perfectly obviously problem! I had much better drug coverage on my retirement insurance policy from my company. Fortunately for them, they were able to write me a sweet little note and kick me off the policy for my equali coverage this last Christmas. If everyone who lied about this noses would grow 12 inches, we would have lots of strange looking people here, especially in Washington and the GOP.

Now I will be paying the next $3000 plus dollars out of my pockets which I have never done in my whole working life. This is crap! However, I can afford it. What about those who can't???? It's back to Mexico, Canada or food or drugs. May those who pushed this program including AARP rot in hell.

Posted by: Rain on June 11, 2006 at 7:21 PM | PERMALINK

Well, not to get back on topic or anything, but there's your problem- liberals frequently don't create programs that work.

The Clinton health plan, for example, obviously wasn't going to help anyone who really couldn't afford care. It started as a patchwork and headed downhill.

Liberals always invite the same old gang to belly up to the table (insurance companies, welfare bureaucracies, university professors, hospital chains) and then sweeten the pot by throwing in a heap of means-testing. Next comes the "prevention is the best cure" gambit, which in effect means the money is spent on people who already have jobs, who will tell the poor to eat an apple a day, etc.

In the end, you get something like the food stamp program, where the applicant repeatedly affirms that they know they may be committing a felony by filling out the application, and in return gets coupons for $12 worth of food stamps.

And this probably won't change much until the coming depression makes 'democrats' into 'extreme democrats'. When you start to think Eleanor Roosevelt is more attractive than Marilyn Monroe, you're getting close.

Posted by: serial catowner on June 11, 2006 at 7:25 PM | PERMALINK

Sadly, American Hawk's droppings here are more commensurate with the opinions of the people that I meet than anybody else's.

You have to give it to the Republicans for convincing the Americans that a cup of battery acid is actually havenly soma.

Posted by: nut on June 11, 2006 at 7:44 PM | PERMALINK

I gotta hunch the donut hole is going to be a Democrat wedge issue. Seniors are going to be there for the asking.

To avoid the wedge I can see the Republicans closing the hole. The smart ones will want to do something.

Democrats need to beat the Republicans to the punch. They won't, of course, Democrats are reactive, not proactive. That is why I am about to loss hope for this election. Everything on a plate and nobody has the balls to take advantage of the Republican's structural insanity.

Posted by: Ron Byers on June 11, 2006 at 7:53 PM | PERMALINK

Who are you? What happened to Amy?

Posted by: jerry on June 11, 2006 at 8:00 PM | PERMALINK

Mmmm, donuts. *drooool*

Posted by: Brian on June 11, 2006 at 8:00 PM | PERMALINK

"I've read speculation that the GOP created the donut hole implementation not to save money (what do they care about that?), but to convince people that government programs don't work."

No, the reason they created the "donut hole" is that was the only way they could convince the Republicans worried about the cost to vote for the program. A large percentage of beneficiaries entire prescription drug needs will be paid out of their pockets due to the hole.

This saves a ton of money, with the added benefit that Republicans can claim to offer this great new benefit to seniors without actually offering much of anything at all to the majority of seniors who need relief from the high cost of prescription drugs.

Posted by: brewmn on June 11, 2006 at 8:10 PM | PERMALINK

whereas, from the most recent stuff I could Google, Merck (MRK) invests $4 billion a year in R&D. Bristol-Meyers (BMY) $2.5 billion. Eli Lilly & Co. (LLY) $2.7 billion. Pfizer (PFE) $1.8 billion. Sanofi-Aventis (SNY) $10.2 billion. even combined, it's less than $27 billion.

Posted by: Nads

I think rd confused R&D with advertising and admin. In 2006 Q1, Pfizer spent $1.59 billion on R&D and $3.81 billion on selling, information and administrative expenses.

Looks like an annual rate of $15+ billion on sales & admin. For just one company.

Add up the rest of the industry and the NIH budget looks pretty slim.

Posted by: pebird on June 11, 2006 at 8:17 PM | PERMALINK

American DumbFuck just doesn't get it. But then, he's a conservativedumbshit and categorically idiotic.

They pay the discount. THE FULL PRICE IS USED TO DETERMINE WHEN THEY GET TO THE DONUT HOLE.

THey are now on a plan. They can't change. Any plan could charge 2500 for a single prescriptino, and the plan members couldn't say a single fucking thing about it.

This plan is the stupidest thing that the Party of Stupid Ideas has ever come up with.

Remember, if they are re-elected, they will do to Social Security what they did to Part D.

Posted by: POed Lib on June 11, 2006 at 8:42 PM | PERMALINK

Hey NON-AMerican Hawk? You one of those H1-B scabs, here to steal our jobs and run down our country?

Go back to your own country. YOUr brand of Fascist crapola reads better ins Deutsch, nich im English.

Posted by: POed Lib on June 11, 2006 at 8:44 PM | PERMALINK

I gotta hunch the donut hole is going to be a Democrat wedge issue. Seniors are going to be there for the asking.

Here's my version: So, you hit the donut hole. This was the republican idea. You get a small benefit, and then you pay it all back,plust you still have to pay money to the plan to pay money for your drugs.

If you re-elect these repukeliscum, THEY WILL DO TO SOCIAL SECURITY WHAT THEY DID TO MEDICARE DRUG COSTS.

Posted by: POed Lib on June 11, 2006 at 8:46 PM | PERMALINK

I read somewheere that the VA on average gets 50% off of drugs by being a large purchaser and negotiating low prices. I've also heard that the medicare drug benefit will save subscribers on average 50% off their drug costs.

If this is true, we could have gotten a drug benefit that was just as effective, and without paying for the insurance company middlemen, simply by pooling purchases and negotiating with the drug companies.

Is this correct? And if so, why isn't someone pointing this out to the voters?

Posted by: karin on June 11, 2006 at 10:06 PM | PERMALINK


The medicare drug benefit pays for $2,250 of total costs and then stops. It picks up again after $3,600. The guy's math doesn't work. $167.56 four times doesn't equal $2,250.

Posted by: Lionel on June 11, 2006 at 10:14 PM | PERMALINK

What's worse, since the press rarely even bothers to report which party supports which stuff, Democrats probably suffer as much from Medicare's donut holes and mind-boggling complexity as Republicans.

That's the purpose of the whole program.

Posted by: eRobin on June 11, 2006 at 10:20 PM | PERMALINK

They pay the discount. THE FULL PRICE IS USED TO DETERMINE WHEN THEY GET TO THE DONUT HOLE.

And the full price is, of course, raised so that they still make a healthy profit on the proportionate discount. Classic trap. And with collective bargaining made legally impossible by the Medicare Part D bill...

Posted by: ahem on June 11, 2006 at 10:23 PM | PERMALINK

The medicare drug benefit pays for $2,250 of total costs and then stops. It picks up again after $3,600. The guy's math doesn't work. $167.56 four times doesn't equal $2,250.

Gosh, a mathematician.

Possibly, just possibly, there were OTHER DRUGS INVOLVED? You think? If you're a republican, obviously not.

The point is, Sherlock, that he paid a small amount, but that it got him to the donut hole because they use the FULL UNDISCOUNTED AMOUNT to get them to the DONUT HOLE.

And here's the kicker: NO ONE TELLS THEM HOW MUCH TO CHARGE!!! THEY CAN OVERCHARGE AND NO ONE CAN STOP THEM.

Once you are in a program, you can't quit, until plan switch time comes. Once you switch, you are stuck again.

Who is stopping the plan managers from charging $2250 / single ibuprofen.

Remember, they can change the terms of their plans at any time, but you can't switch.

Posted by: dataguy on June 12, 2006 at 12:24 AM | PERMALINK

I'll bet you dollars to donut holes that if the Democrats wanted to, they could find a large, angry group of elderly voters willing to give the Republican party a beat down just because of this issue alone. If only they weren't such wishy-washy pussies...

People hate bullies like the Republicans but they hate the victims that kiss their feet even more. The Democratic unwillingness to come out swinging HARD engenders disgust, not even pity, just disgust.

Posted by: Eric Paulsen on June 12, 2006 at 12:35 AM | PERMALINK

America Hawk says -
The senior citizens are getting something for nothing. Why is asking them to pay for a small percentage of their own medicine too much to ask? Why is it more fair to ask for me and people currently working to pay, but not them?

I'm American now. Doesn't mean I was born here. My only citizenship, however, is with the USA.


So, American Hawk, you were not born here. You immigrated from another county. Why? You thought America offered a better opportunity? I think you are right. But why is the opportunity better here?

I think its because, since our revolution, Americans have fought and died to provide and preserve that opportunity for us. And you got the benefit just by walking through the door. Because for over 200 hundred years Americans have worked hard, and many suffered and died, doing the hard work to get us where we are today. And you benefited by moving here.

The people on medicare are elderly (such as myself full disclosure), and most all of them have worked their whole lives (me, again) to give you the country you decided to call home. Many have also fought under the American flag, and risked their lives (yes, me) to fulfill what we thought was our obligation to our country, and our people.

Im glad you felt America offered you the best opportunity to succeed. It means the hardships and sacrifices of all those previous generations were not in vain.

You know, American Hawk, whether we are here by accident of birth, or immigrated, we all start out with an advantage. We get to climb the next rung of the latter on the shoulders of those who came before us. So you see, these people arent getting something for nothing. They provided the advantages you moved here for. And its not unfair for you to contribute to the benefit of these others. They have made it possible for you to do so.

Im glad you are now an American but remember, we are now, all in this together.

Posted by: usmc0311 on June 12, 2006 at 12:56 AM | PERMALINK

This is for Hawk and Hawk alone...I am one of those Medicare "freeloaders" you speak so inaccurately about...I pay 88.50 per month for Medicare part B to cover my doctor's visits and medical care. I pay 133.00 per month for the Medicare part D drug coverage. In all I pay 213.00 per month for medical insurance out of my disability check of LESS than 875.00 per month. Check your facts BEFORE you start pulling stuff out of thin air. If you think my life is so damned terrific and fun let's trade places...you can have my medical problems and failing heart and pain and my HUMONGOUS disability check and go live high on the hog like you apparently think I do. I worked ALL my life from age 15 to age 41 before I got sick and couldn't work anymore if I wanted to keep living. although I suppose you would say "if she's going to die then let her do it and decrease the surplus population." That would certainly keep me from getting all this wonderful free care and something for nothing now wouldn't it? Conservatives believe in a culture of life my ass...

Posted by: talidapali on June 12, 2006 at 1:25 AM | PERMALINK

I have been informed that the Insurance companies can deduct the amount that the insured pays out of his/her own pocket as part of the company's expenses for tax purposes! Nor can they go to another pharmacy where the drugs are cheaper to fulfill their "donut hole" obligations. Nor can they buy additional insurance to cover the "do-nut hole". Nor can they change their insurance company until a year after they have signed up but the insurance company can change the price of any drug at will--or discontinue any drug at will.

Posted by: aRuss on June 12, 2006 at 3:59 AM | PERMALINK

I'm American now. Doesn't mean I was born here. My only citizenship, however, is with the USA.

Posted by: American Hawk on June 11

Take his citizenship and passport back and deport the ignorant clown.

Posted by: UDT on June 12, 2006 at 5:21 AM | PERMALINK

"Considering the federal government underwrote much of the research and the researchers, the actual cost of prescription drugs should be damned affordable anyway."

read a bit abpout epoetin alpa, the "orphan drug" financed by the government, and generating BILLIONS in profit for Amgen- http://www.sciam.com/article.cfm?articleID=00090696-B9E6-1E90-8EA5809EC5880000

Posted by: dhonig on June 12, 2006 at 7:28 AM | PERMALINK

People from Red States deserve to suffer. A lot.

Posted by: Hostile on June 12, 2006 at 12:01 PM | PERMALINK

And what about the fact that the legislation prohibits shopping in Canada or Mexico for better prices.

Yikes.

Amazin

Posted by: Amazin on June 12, 2006 at 12:23 PM | PERMALINK

First off, there is no "Medicare Prescription Drug" program, as Medicare was specifically blocked from offering a plan by the Republican legislation. It's a PRIVATE-SECTOR Corporate Prescription Drug program.

Secondly, the majority of the spending appropriated under the Republican legislation is NOT for providing prescription drugs for seniors, but for CORPORATE WELFARE for the pharmaceutical companies, corporate HMOs, and for-profit corporate hospitals.

It's Korporate Amerika that is "getting something for nothing" (except for their political contributions), not seniors.
.

Posted by: VJ on June 12, 2006 at 12:58 PM | PERMALINK

Karin,

If this is true, we could have gotten a drug benefit that was just as effective, and without paying for the insurance company middlemen, simply by pooling purchases and negotiating with the drug companies.

Is this correct? And if so, why isn't someone pointing this out to the voters?

Many congresscritters in the Democratic Party have been pointing this out. Pelosi is just one example. The fact that you aren't aware of this is just one more data point in the proof that the Liberal Media is nothing more than a Conservative talking point.

Posted by: Edo on June 12, 2006 at 1:59 PM | PERMALINK

Wow. Im really surprised by the vitriolic responses to American Hawk. Maybe in other threads, or perhaps in the meat world, Hawk is a big flaming jackass. Beats me. But in this thread, didnt he, you know, make a sort of reasonable point?

Kevins original post criticized the incomplete subsidization of Medicare prescription beneficiaries. Maybe Kevin is right. Maybe we ought to further subsidize that class of persons. It seems to me, however, that thats a matter on which reasonable people can differ.

Maybe I didnt get the memo: is eliminating the Medicare donut (i.e., subsidizing Medicare beneficiaries even more than we already do) the sine qua non of liberalism now? Or even, as Kevin suggested when he called Hawk a wingnut, does dissenting from Kevins position also disqualify you from being a centrist?

Jeez.

Posted by: Elias on June 12, 2006 at 4:46 PM | PERMALINK

Hey Data Guy

You need an education! If you think a pharmacy can charge any amount for prescription and medicare will pay it, you are crazy. I just looked up Byetta and it isn't a covered medication in the medicare formulary of my plan.

Posted by: Lionel on June 12, 2006 at 10:39 PM | PERMALINK




 

 

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