Tuesday, June 23, 2009

Implementation is going to be a problem...

The whirlwind healthcare reform debate of 2009 needs to review the implementation issues of the Medicare Part D program of 2006 in order to not repeat the mistakes of the recent past. The Medicare Prescription Drug Improvement and Modernization Act (MMA) is a relevant case study of the modern American government’s capability to manage a large and relatively quick shift in health policy. By analyzing the issues that cropped up in MMA, specifically administrative and outreach glitches in Medicare Part D implementation due to time constraints, the government will be better able to empirically assess the dynamics of a complete healthcare system overhaul.

The Congressionally mandated timetables did not give the Centers for Medicare and Medicaid Services (CMS) enough time to properly implement the new programming.
Medicare Part D was signed into law on December 8, 2003 and went into effect on January 1, 2006. During the interim time, CMS created the final regulations governing the entitlement program. CMS completed that preliminary task in January of 2005. Under the Congressionally mandated timetable, less than a year was left to educate all eligible seniors before enrollment began in November, 2005. State officials repeatedly warned the federal government that the enrollment of 6.4 million poor seniors would take more time because, among other issues, those seniors form one of the population subsets least likely to open their mail.

The fast growth of the actual Medicare bureaucracy also caused problems in the administration of the new programming. The CMS employee roster increased 11% in one year in order to accommodate the new policies. Before MMA, CMS had 4,500 employees. In order to administer the Medicare D drug benefit they hired 500 new employees. One of the most famous administrative problems that arose from these staff increases was the $50 million mistaken refund sent to 230,000 enrollees.

Health experts, members of Congress, and seniors all warned that a two year government turnaround would result in massive disruptions of existing drug coverage for poor seniors. There were calls from within Congress to slow the advent. A bill (H.R. 1382) was introduced by Jeff Flake (R-AZ) to delay the start of Medicare D by one year and continue with the Medicare drug discount card and subsidies to low income seniors during an extended education and implementation process. Our current House Speaker, Nancy Pelosi (D-CA), also called for an extension of the registration period. These calls went unanswered and there were major disruptions for elderly prescription drug coverage in January, 2006.

Back in 2003, Congressionally mandated timetables of implementation were too fast for the program to have time to gear up successfully and resulted in unnecessary administrative problems and failures to reach its intended audience. The current healthcare overhaul bills in Congress would create policy changes that would be implemented as soon as next year. This is clearly foolhardy based on Medicare D’s track record. Congress needs to realize that the problems associated with Medicare Part D, which only dealt with 10% of the US dollars spent on healthcare annually, will be magnified in a complete healthcare overhaul. Therefore, the federal government needs to allow more time and debate, not less, before passage and implementation.

Tuesday, March 31, 2009

Medicare Part D is the Best Litmus Test for How Well the Federal Government will Dispense Health care to Americans

The implementation of Medicare Part D is the best case study of how well our modern American government will administrate the new health care reforms. Simply put, this piece of legislation and its ramifications should be on of the most significant factors in the dialogue over health care reform in 2009 because it was health care reform in 2006. The mistakes of three years ago are the best indication of the mistakes to come in reforming health care in 2010.

Yesterday, Congress began to consider the budget resolutions with their health care proposals. They are expected to vote on them this Thursday. In 2010 we will have a new health care system model.

The last time Congress rushed health care reform, they harmed the seniors they were trying to help. Medicare Part D was signed into law on December 8th, 2003 and went into effect on January 1, 2006. The administrative glitches, loss of coverage, and confusion among seniors, pharmacists, and their doctors served as a daily reminder that government could not take care of everyone.

Back in 2003, Congress faced a legitimate problem. Some American seniors could not afford to pay for their prescribed medications and drove up the cost of Medicare for taxpayers. Congress’ solution was Medicare Part D. Part D is a prescription drug entitlement program administered by Medicare as part of the Medicare Prescription Drug Improvement and Modernization Act (MMA) signed into law on December 8, 2003.

Once the MMA was signed into law, the Centers for Medicare and Medicaid Services (CMS) went about the task of creating the final regulations governing the entitlement program. It took until January of 2005 for them to complete that preliminary task. Under the Congressionally mandated timetable, that left less than a year to contact and educate all eligible seniors before enrollment began in November of 2005 and the new program went into effect on January 1, 2006.

The most central problem was that the Medicare bureaucracy could not handle the administration of Part D without expensive administrative glitches. The program was too unwieldy.

For example: CMS needed to hire 500 new employees to administer the drug benefit. At the time, they had a staff of 4,500 employees. In one year they needed to increase their staff by 11%. Any MBA will tell you that employment increase alone would cause integration nightmares and glitches, and it did. One of the most famous was the $50 million mistaken refund to 230,000 enrollees. http://seniorjournal.com/NEWS/MedicareDrugCards/6-10-02-SenateAgingChair.htm

The second problem was the massive disruption of existing drug coverage for poor seniors. State officials repeatedly warned the federal government that the enrollment of 6.4 million very poor seniors faced practical problems like the fact that those seniors are one of the population subsets least likely to open their mail. Please click here for a USA today article from January 2006 detailing the disruption. http://www.usatoday.com/news/opinion/editorials/2006-01-19-our-view_x.htm

Health experts, members of Congress, and seniors all warned that the two year government turnaround was too fast. There were calls from within Congress to slow the advance. A bill (H.R. 1382) was introduced by Jeff Flake (R-AZ) to delay the start by one year and continue with the Medicare drug discount card and subsidies to low income seniors during the education and implementation process. Our current House speaker, Nancy Pelosi (D-CA), called for an extension of the sign up time.

Back in 2003, two years was considered a fast turnaround for government health care legislation. Part D only dealt with 10% of the US dollars spent on health care per year. In 2009, Congress is trying to change how 100% of health care dollars are spent per year in one year. Can you even imagine the glitches that will occur?

Don't take my word for what happened. Google search it yourself. These issues aren't as complicated as they want you to think.

Eat a burger and do some homework.

:0)



Wednesday, March 25, 2009

If you're almost broke...don't fix it yet

Reality: the American government is almost broke. It is flat out, can’t rub two dimes together, unable to continue with the margin of largesse it enjoyed in the past, almost broke. Not even the USA can “spend” $1 Trillion in less than a fiscal quarter and still enjoy a seemingly limitless discretionary budget.

So where do we go from here?

The good news is that an almost broke country still has a chance to survive…as opposed to a bankrupt country. America can still afford the basics like troops in Afghanistan and fuel for Air Force One. It will survive…eating ramen three times a day.

If this country wants some of the “pricier” things a government can offer, like a hybrid for every home, it needs to wait for the economy to expand so its tax revenues increase. An increase in tax revenues could lead our government officials to rationally consider expanding government programs.

(Please note that for the sake of everyone’s sanity I have set aside the debate over the proper role of government for the moment. You’re welcome.)

For fiscal year 2009, the US government is expecting lower tax revenues. There has been a contraction of economic growth in the US economy. A literally incalculable amount of wealth has been destroyed in America.

At the same time, the US government has decided to secure toxic assets, invest in clean energy, and create multiple new government agencies. Any potential discretionary budget the government could have pretended to have has already been spent.

Why then is the US government trying to fix the problems with American healthcare this fiscal year? This is one of the worst times in all of American history to consider the government accepting the responsibility and expense of healthcare reform. The government is almost broke. We can’t afford it.

Wouldn't it make more sense to make this the year of health care reform dialogue, allow the economy to recover, and then tackle this issue?

R-A-M-E-N

Friday, March 13, 2009

A Pensive Burger

I blog to you today as a perplexed and sad burger lover. I came up with the concept for this blog as a way to showcase that a few obvious truths and some elbow grease are the way to fix the health care issues facing the United States. Tonight I can’t say for sure that is true.

I am dealing with an inverse relationship; the more I study this issue the less I understand. It feels like trying to decipher a derivatives market in grade school.

What makes it worse is the real suffering going on behind closed doors. The horror stories from people fighting insurance companies for treatments that they thought they paid for in monthly installments are devastating. I refer you to Time Magazine’s article by Karen Tumult, “The Health Care Crisis Hits Home”

My gut tells me that the issue should be far less complicated than it appears today.

There are certain truths that I hold to be self evident, and one is that if a policy issue is too confusing then someone is benefiting from it. I think there are many who are confusing us in order to "win" in the health care debate. Insurance companies, drug companies, politicians, and doctors are on that list.


So I will carry on with this concept and make it about good faith. According to dictionary.com, the term "good faith" refers to "having honest intentions."

The regular gal, like me, can’t stay quiet because other people appear smarter. I think that the major truth that we face in this watershed debate is that the ones who pretend to have all of the answers are lying because their motives don’t align with ours. A system that is insolvent is better for their bank accounts than the system that could be solvent.

It is on this backdrop that I will present what I find to you and hope that you will return the favor. We need to fix this ourselves and I look forward to working beside you in good faith.

I think I need to nibble on another burger and think for a while.

G’night.

Monday, March 2, 2009

Flame Broiled Common Sense Burger Hit Counter