[Homestead] Ideological nightmare conflicts with Medicare reality

Tvoivozhd tvoivozd at infionline.net
Tue Sep 28 14:45:10 EDT 2004


When Our Maximum Leader's ideology conflicts with reality---ideology 
wins every time, not just in tax cuts, environment and energy, in the 
health and healthcost of you and your family.

His PPO mania is killing people and costing taxpayers a fortune---the 
fact that his conduct is wildly illegal does't bother him a bit..


The New York Times
------------------------------------------------------------------------


          September 28, 2004


    Inquiry on Medicare Finds Improper Limits on Choices

*By ROBERT PEAR*

WASHINGTON, Sept. 27 - Federal investigators said Monday that the Bush 
administration had improperly allowed some private health plans to limit 
Medicare patients' choice of health care providers, including doctors, 
nursing homes and home care agencies.

The investigators, from the Government Accountability Office, also said 
that the private plans had increased out-of-pocket costs for the elderly 
and had not saved money for the government, contrary to predictions by 
Medicare officials.

The study, the most comprehensive assessment of a demonstration project 
that the administration has described as the best hope for Medicare's 
future, focused on the program's experience with a form of managed care 
known as preferred provider organizations, the type of health insurance 
most popular among people under 65.

Medicare is spending $650 to $750 a year more for each beneficiary in 
such private plans than it would have spent if the same people stayed in 
traditional Medicare, the investigators said.

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.

The accountability office, a nonpartisan investigative arm of Congress, 
said the administration "exceeded its authority'' by allowing P.P.O.'s 
to limit patients' choices of providers offering skilled nursing and 
home health care, dental care and routine physical examinations.

In many cases, it said, the private plans covered such services only 
when beneficiaries used health care providers designated by the plans 
themselves. Beneficiaries who went outside the network of preferred 
providers were often "liable for the full cost of their care,'' the 
report said.

"By law,'' it said, "these plans should have been required to cover all 
services in their benefit packages even if those services were obtained 
from providers outside the plans' provider networks.'' But, it said, the 
administration waived this requirement for 29 of the 33 preferred 
provider plans, allowing them to deny coverage for some services 
obtained outside their networks.

The administration "did not have the authority to allow plans to 
restrict enrollees' choice of providers'' as it did, the report said.

Normally, preferred provider plans encourage patients to use certain 
doctors and hospitals, but allow them to use other health care providers 
for an additional cost.

The accountability office, formerly the General Accounting Office, found 
that the administration had "improperly waived the requirement'' for 
P.P.O.'s to let Medicare patients choose their health care providers.

The findings are a significant setback for the administration, which 
wants to triple enrollment in private plans in five years. About 4.7 
million of the 41 million Medicare beneficiaries, or 11.5 percent, are 
now in private plans, most of them H.M.O.'s.

In January 2003, the Bush administration began the demonstration project 
encouraging beneficiaries to join P.P.O.'s, which in theory offer more 
choice than H.M.O.'s.

Ten million beneficiaries were eligible for the preferred provider 
plans, but only 105,000 had enrolled as of last month, the report said.

To comply with the law, the accountability office said, Medicare 
officials should immediately instruct these private plans to provide 
coverage for "all plan services furnished by any provider'' willing to 
accept their payments.

Dr. McClellan said, "We will comply with the recommendations made in the 
report.'' Moreover, he said, the government will work with private plans 
to ensure they follow the law.

Senator Max Baucus of Montana, the senior Democrat on the Senate Finance 
Committee, who requested the report, said the administration's claims 
about private plans were "not based on reality.''

Mr. Baucus, who voted for the new Medicare law, said, "While I believe 
in choice, I also believe that private plan options, including P.P.O.'s, 
should be added to Medicare only if they bring value to beneficiaries 
and taxpayers.'' Contrary to assertions by Medicare officials, Mr. 
Baucus said, auditors found that P.P.O.'s "are more expensive, to both 
taxpayers and enrollees.''

To draw P.P.O.'s into Medicare, the report said, the Bush administration 
offered to pay them more, waived stringent standards for the quality of 
care and removed limits on the costs that beneficiaries might be 
required to pay. As a result, it said, these plans were "subject to no 
statutory or regulatory limits on cost-sharing'' for beneficiaries.

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.

The demonstration project, offering P.P.O. plans in 214 counties, runs 
through 2005. Medicare officials hope to offer such plans in all parts 
of the country in 2006.

In the future, Dr. McClellan said, "P.P.O.'s will be a familiar and 
popular choice.''


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