Tuesday, September 28, 2004

Medicare flim-flam from the Orwell Administration

An earlier, slightly different, version of this entry appeared in my DailyKos diary.

***************

For just a few minutes earlier today, an important story on the Bush lies about Medicare appeared on the front page of the New York Times site.  Then, quicker than you can say “General Accountability Office”, it vanished into website limbo, buried near the bottom of the NYT’s “National” page.  For the record, the story is on page A17 of the dead-trees version of the Times.

Those intrepid patriots in the GAO have once again demonstrated that there is no connection between Bushista rhetoric and objective fact.  As Times reporter Robert Pear drily puts it near the end of the article:

The report was the fourth in two years to find that the administration had skirted federal law in pursuing health policy objectives. In July 2002 and last January, the accountability office said the administration had improperly allowed states to divert money from the Children’s Health Insurance Program to provide coverage for childless adults.

Earlier this month the auditing agency said that the Bush administration had illegally withheld data from Congress on the projected cost of the new Medicare law.

This time, the GAO offers its assessment of a Centers for Medicare & Medicaid Services (CMS) demonstration project ... a preferred provider organization (PPO) model, running since January 2003 in 214 counties around the country.  The demonstration purports to show that PPOs would be better than traditional fee-for-service Medicare in both cost and beneficiary coverage.

Instead, the GAO found that the demonstration actually costs Medicare an extra $650-750 per beneficiary, even though the project acceded to the demands of the insurers, waiving statutory benefit and coverage requirements in 29 of the 33 PPOs in the study.  In other words, the plans were allowed to deny coverage for some services if they were obtained from out-of-network providers. 

That’s not the way a PPO is designed to work.  What’s supposed to happen is that the plan makes it more expensive for beneficiaries to obtain services from non-PPO sources, in order to encourage and incentivize subscribers to use in-network providers, presumably under an agreement to accept lower payments than they might otherwise have obtained.  However, in every PPO I’ve ever run across, there will be some defined coverage for services performed by out-of-network providers.

Thus, not only did this PPO demonstration cost Medicare more than the traditional model, some beneficiaries faced large out-of-pocket expenses for denied coverage of services that would have been partially reimbursed under the traditional model.  Truly a lose-lose proposition.

This is another of those Orwellian black-is-white programs so emblematic of the Bushies.  Traditional fee-for-service Medicare allows a beneficiary to obtain covered services from any doctor, hospital, nursing home, home health agency, lab, rehab facility, etc.  No assigned primary care “gatekeeper”, no “referral network”.  How much more freedom of choice can a beneficiary have than that?  Certainly not in a PPO, not even one that (unlike most of the plans in the demonstration) actually pays something for out-of-network services.  Yet PPOs, and, even worse, the bastardized and misrepresented atrocities in this Medicare demonstration, are hawked by the malAdministration as somehow increasing the choices available to Medicare beneficiaries.  It defies logic and common sense.

But that’s not exactly breaking news by now, is it?  Certainly not in the Bush netherworld of Dr. Mark McClellan, administrator of CMS (Medicare’s parent agency).  According to Pear’s article,

In negotiations over the Medicare bill last year, the administration pressed for more money and authority to foster the growth of preferred provider plans, saying they would be more efficient and would save money over time. Administration officials reiterated that view on Monday.

After reviewing the report, Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, insisted that private plans were “an attractive option” that would save money and improve coverage for beneficiaries.

Oh, by the way, did I mention that the CMS administrator bears a rather striking resemblance to another high-ranking official in the malAdministration?  Quite the family…