Final battle for future of US healthcare draws near
pharmafile | October 29, 2003 | News story | |Â Â Â
The future of the US healthcare system and how patients pay for their medicines will be decided in the coming weeks as a long-running battle for change reaches its climax.
Whatever happens, the Medicare healthcare system will undergo its furthest-reaching reforms since it was established in the 1960s, but two rival plans for how to extend insurance for prescription costs are dividing politicians on Capitol Hill.
Forty million 'seniors' currently have their hospital and doctorsfees paid by the health insurance system, but often face huge bills to pay for their prescription drug costs.
Neither the House or the alternative Senate bill are seen as perfect, but many consumer groups are adding last minute pressure to see the latter pass into law, possibly in late July.
The House bill would see patients pay up to $250 per year, after which they will only pay 20% of costs up to $2,000. After prescription costs reach the at 'castrophic' level $3,500 the full cost would be paid by the Medicare system. This coverage would cost seniors around $35 per month, with the House claiming the deal would be good for the majority, with average annual spending currently around $1,285.
From 2010, this system would encourage direct competition between Medicare and private health plans, which Republicans say will encourage cost controls, but which Democrats say will mean the effective privatisation of the state-run health insurance scheme.
The Senate bill would cost seniors the same amount, and would allow them to add a standalone private drug plan or join a new scheme called Medicare Advantage. In either of these schemes, for costs between $276 and $4,500, patients would pay half, with full insurance for between $4,500 and $5,800. After this point, seniors would have to pay 10% of costs.
The Senate bill also includes inducements to enter private healthcare insurance, but advocate groups strongly favour it over the House bill. A compromise must be reached to turn the bills into a single piece of legislation, but Families USA is urging Senators to reject the House bill to stop what it sees as the privatisation of Medicare.
Both Families USA and Public Citizen say the House bill will effectively transform Medicare into a private insurance plan, restricting patients' choices of doctor and benefits, and inflating premiums to unaffordable levels.
"The House bill will clearly force seniors and people with disabilities to leave traditional fee-for-service Medicare and join HMOs and private for-profit managed care plans," said Families USA. "In a few years, the House bill's scheme will drive up Medicare premiums, making it unaffordable except for the very rich."
Frank Clemente, Director of Public Citizen Congress Watch, said: "Medicare should continue to offer all people eligible for the program a guaranteed set of benefits at a known price. Private insurance plans will not do this; they make money by scrimping on care and discriminating against the sick."
Meanwhile, President George Bush has been touring the country to promote the House bill.
"Medicine is changing; Medicare is not," the President told an audience at the Illinois State Medical Society in Chicago. "As many as one-third of seniors on Medicare have no drug coverage at all. It about 900,000-90,000 seniors in Chicago without any drug coverage. Because seniors don have coverage for prescription drugs and preventative care, we are creating a health care system that is more expensive and less effective."
Mr Bush gave as an example the use of ulcer drugs and blood thinning drugs as cost-effective spending compared to hospital care for patients with ulcers and strokes.
Congress has already approved the administration budget of $400 billion over 10 years to pay for prescription costs in whichever system wins through, though consumer groups say this sum still falls short of the funding needed.
US industry association PhRMA welcomed the developments, but said important issues "remain to be resolved." The organisation has refrained from taking sides so far, and it remains uncertain if one system would be more favourable to the industry than another.
