Monday, September 27, 2010

Life and/or Death under Medicare

Two seemingly unrelated items come to our attention. FoIB Bob D tips us that " (m)illions of seniors face double-digit hikes in their Medicare prescription premiums next year unless they shop for cheaper coverage."

The article refers to so-called Medicare Part D plans (ostensibly, the "D" stands for "drugs;" IB readers know that it actually stands for "debacle"), which are due to change in January. These plans are necessary evils for seniors, who must decide not only whether or not to buy one but also which one among the myriad of choices available.

Well, best scratch that "myriad of choices available," since the market is shrinking:

"Medicare "is really reshaping the market ... There are a lot of plans that are shutting down."


For example, AARP's "MedicareRx Saver" plan (actually issued by United Healthcare) has some one and a half million subscribers, but it's about to be shelved in favor of the more expensive "MedicareRx Preferred" plan. And get this: "Seniors who are already in the AARP Preferred plan ... will see their premiums fall 11 percent on average," subsidized by the folks coming from the erstwhile "Saver" plan. How's that for fair?

And speaking of fair, Medicare isn't just about premiums, it's about coverage. As we saw with the recent Avastin kerfluffle [ed: you really like that word, don't you?], there's more than a little controversy about how end-of-life issues will be treated going forward. FoIB Jeff M points us to news that "Provenge, a first-of-a-kind therapy approved in April ... costs $93,000 a year and adds four months’ survival, on average, for men with incurable prostate tumors."

There are, of course, a number of questions which arise from this. The first, obviously, is the efficacy of spending nearly a hundred thousand dollars for an additional few months of life. Who gets to make this call? The patient? His family? Unaccountable government bureauweenies?

The second is how, or even if, these kinds of medications will continue to be covered. One option, of course, would be for Insurer A's Part D plan to cover it (meaning higher premiums) and Insurer B's to exclude it. That seems like a rational, free-market solution, but is that how it will unfold?
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