BigGovHealth Improve and Strengthen Health Care for all Americans

Medicare and Medicaid

Myth: The elderly could end up paying more for their prescription drugs today than they did before Congress passed the Medicare Modernization Act.

Fact: An August 2006 Public Opinions Strategy poll revealed that, on average, seniors are paying less than half of what they paid monthly for medicines before Congress enacted Medicare Part D thanks to the market mechanisms included in the program. “Only three million of the 23 million seniors who participate in the program will experience a gap in coverage – or the so-called ‘doughnut hole’ which kicks in after the senior and government have spent a combined $2,250” – according to the Kaiser Family Foundation survey. One million of these seniors will receive “catastrophic” coverage, while lower-income seniors are eligible to receive additional financial assistance. And most seniors can avoid the doughnut hole altogether by choosing one of the plans under Part D that offers gap coverage.

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Myth: The Medicare Part D plan will hand over $800 billion of our tax dollars to the pharmaceutical and health insurance industries.

Fact: The Centers for Medicare and Medicaid Services (CMS) reported that the cost of Medicare Part D is $189 billion less than predicted. The CMS cost estimates refer to program administration, not profit made by the pharmaceutical and health insurance industries. Insurance companies offering Medicare Part D plans are not-for-profit as well as for-profit.

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Myth: Medicare and Medicaid are low-cost, efficient government programs that offer quality care

Fact: Those who participate in these programs face burgeoning bureaucracy, desperate attempts to cut spiraling costs, and impersonal, unbending dictates about care handed down from above.

Even taking into account health-related factors and socio-economic differences, Medicare and Medicaid patients fare worse than their commercially insured counterparts and are less likely to receive the gold standard treatment.

Medicare and Medicaid patients often receive checklist medicine, with the appropriate treatments determined by bureaucrats or doctors without specialty in the area and influenced by attempts to cut costs. At the same time, standards and eligibility vary widely in different parts of the country.

The price tag of Medicare and Medicaid is huge and growing all the time. It is already unsustainable. Some attempts to cut costs have taken care away from patients through rationing and refusal to cover some treatment, while the success of more market-driven programs, like the Part D drug benefit, has been disparaged by those who want to stick to government-run care. Regulations also make it difficult for doctors to treat Medicare and Medicaid patients because the reimbursement is too low. This leaves fewer physicians willing to treat people in these programs. The low administrative costs of these programs reflect less staff to carry out “consumer services” and “provider support” among other beneficial services.