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A Better Solution than Prescription Benefits
Congress can reinstate HMO viability for seniors now

By Dorothy Anne Seese
dottie@politicalusa.com

2/6/2001

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President Bush realizes that something urgent needs to be done to help seniors, and his main focus is on prescription drugs, which is an area of extreme concern to many.  Republican health care reform advocates in Congress, along with some Democrats, realize that just tossing money at the states and trusting them to implement programs for the low-income elderly will result in varying degrees of success.  Many states are just plain stupid when it comes to legislative action and I live in one of them:  Arizona.

Between two-thirds and three-quarters of Arizona's vast territory is considered rural, and the Health Maintenance Organizations have pulled out.  Most have pulled out of all of Arizona, including the major metro areas such as Phoenix and Tucson.  A few have remained viable in the Phoenix and Tucson metroplexes, and I belong to one that is community based in the Sun Cities area.

The major advantage of the HMO for low-income seniors is that prescriptions are covered, with a variable co-pay from $10 for generics to $30 for brand names. The co-pay for a doctor visit is usually $5 or $10.

Let me say I am entirely sympathetic with President Bush's interest in getting help to seniors immediately.  I also understand that to get a sharply divided Congress to act is going to take some diligent effort.  Still, I believe that President Bush can get the action he wants to afford some immediate help to our low-income seniors.

Make no mistake about it, the HMO was the government's idea, and right now, with the costs of health care rising and the cost of prescription drugs soaring, revitalizing the HMO is the easiest and fastest way out of a very ugly situation for older people who are not only on fixed incomes, but fixed at deprivation levels.  Arizona is also a neighbor to California, and California's energy problems are trying to spill over here to increase our energy rates.  For many, this means increased suffering during the blazing hot summers.

This isn't a problem for stopgap measures.  But we need urgent help.

Why can't Congress simply take the present caps off the Health Care Finance Administration's ceilings on payments to HMO's?  If the HMO's returned to rural Arizona and those that left Arizona's metro areas returned, senior care with prescription benefits would be available to our low-income elderly immediately. Further, the inefficient state government would not have to get involved with any more of its money-wasting fiascos.  (The Arizona legislature just isn't all that bright.)

Not everyone who chooses an HMO is at or below poverty level, but the way HMO's control health care, anyone who can afford Medicare supplemental insurance with prescription benefits would likely choose that route, thus reducing the possibility of much drain on an HMO program by those who can afford to pay.  The Medicare HMO's are largely for those who can't afford the better option of a Medicare supplement policy.

Rather than force the states into immediately administering new programs for which they are ill-prepared, it is simply easier to use the funds designated for prescription drug benefits to reinstate the HMO viability by lifting the ceilings on the cost of procedures and funding the prescription drug benefits.  Further, the HMO's could be realigned to check on income status quickly and efficiently, thus enabling the lowest income people to receive a higher benefit with lower co-pays.

That would leave the balance of the funding for prescription drug care solely for those regions that still would not have Medicare HMO coverage.  In such cases, the administration could be taken care of by pharmaceutical providers who are equipped to handle and are now handling third-party prescription claims by members of health insurers.

Actually, the structure is in place, it just isn't available in all places.  Since insurance companies are businesses, Medicare HMO's are not the best answer, but far worse was the horrible Democratic-sponsored idea of socialized medicine.  At least the HMO's are businesses, not government boondoggles.

It would be this writer's request for President Bush to take another hard look at restoring the Medicare HMO first, now and immediately, because I believe it would be the fastest, easiest and least costly to the taxpayer.  I believe it would get benefits to the seniors faster than any other route.

President Bush grasps ideas quickly and moves rapidly to effect his programs.  He has a good agenda.  Somehow, either he is not fully aware of the HMO problem or Congress has scuttled it to the point it would take a lot of repair work.  But we're dealing with billions of dollars here.  Insurance companies will move faster to reinstate what they cancelled than legislatures can to develop a long range plan in a short period of time.

This HMO-revival program would give the state legislatures time to think out a viable plan for long-range eldercare, which is badly needed by our nation's senior citizens.  More of us are getting older and, as I have found out to my great annoyance, the older you get, the more work you become to yourself.  (Of course, I am disabled from a spinal fracture, otherwise I wouldn't even be retired.  Our new Secretary of Defense, Donald Rumsfeld, is three years older than I am, but he doesn't have a busted up backbone.)

HMO's weren't the brightest idea our government ever came up with, but in the long run, they do give lower income seniors basic medical and prescription coverage.  They were doing the provider's basic job until HCFA put the ceiling on payments in 1998.  When HCFA cut the money, the insurers cut off the program and left several million seniors without anything but basic Medicare (with monstrous deductibles) or the option of obtaining one of the costly Medicare supplemental insurance policies.  In any event, far too many seniors cannot get any medical or prescription coverage now.

The plight of low-income seniors takes more than just providing a prescription drug program.  One obvious reason is, it takes a doctor to write the prescription.

Dorothy Anne Seese, 2001

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