Wednesday, January 18, 2006


And the private insurance fund contributors get lumbered with paying for the problems the legislators and bureaucrats created

With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was previously taking, and it said that poor people must not be charged more than $5 for a covered drug. The actions came after several states declared public health emergencies, and many states announced that they would step in to pay for prescriptions that should have been covered by the federal Medicare program.

Republicans have joined Democrats in asserting that the federal government botched the beginning of the prescription drug program, which started on Jan. 1. People who had signed up for coverage found that they were not on the government's list of subscribers. Insurers said they had no way to identify poor people entitled to extra help with their drug costs. Pharmacists spent hours on the telephone trying to reach insurance companies that administer the drug benefit under contract to Medicare. Many of the problems involve low-income people entitled to both Medicare and Medicaid.

In a directive sent to all Medicare drug plans over the weekend, the Bush administration said they "must take immediate steps" to ensure that low-income beneficiaries were not charged more than $2 for a generic drug and $5 for a brand-name drug. In addition, it said insurers must cover a 30-day emergency supply of drugs that beneficiaries were taking prior to the start of the new program.

In an interview yesterday, Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said that "several hundred thousand beneficiaries who switched plans" in December may have had difficulty filling prescriptions in the last two weeks. In California, officials estimate that 200,000 of the state's 1.1 million low-income Medicare beneficiaries had trouble getting their medications. Despite these problems, Dr. McClellan said, Medicare is now covering one million prescriptions a day. With the latest corrective actions, he said, "all beneficiaries should be able to get their prescriptions filled."

In the past, such predictions proved to be premature. New problems appeared as old ones were solved, and some insurers were slow to carry out federal instructions. Since the program began on Jan. 1, many low-income people have left pharmacies empty-handed after being told they would have to pay co-payments of $100, $250 or more. About 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program. "The new federal program is too complicated for many people to understand, and the implementation of the new program by the federal government has been awful," said Gov. Tim Pawlenty of Minnesota, a Republican. On Saturday, he signed an emergency executive order making the state a "payer of last resort" for the out-of-pocket drug costs.

The Bush administration said it was rushing to provide insurers with correct information about the extra subsidies available to low-income people enrolled in their plans. "We sent files to all plans providing complete information on dual-eligible beneficiaries" entitled to both Medicare and Medicaid, Dr. McClellan said. "The plans now have all the information in one place." The new drug benefit is the most significant expansion of Medicare since creation of the program in 1965.

More here

Ordeal for woman injured just outside a large public hospital

A one-minute trip to hospital became a 44-minute ordeal for a woman suffering serious head and chest injuries, as the human cost of the Caboolture hospital emergency department closure was revealed yesterday. On the first day of the Beattie Government's contingency plan for Caboolture, a fatal accident just 250m from the hospital's entrance resulted in a lengthy ambulance trip to Redcliffe for a 50-year old female patient. And it forced a 77-year-old with more serious injuries to wait for more than an hour to be airlifted to Brisbane. A 97-year-old female passenger, who had been receiving treatment at the hospital, died in the accident.

After weeks of denials, the State Government admitted yesterday that emergency services at Caboolture were effectively closed as a result of a statewide doctor shortage. The Caboolture Hospital's emergency department was closed from 6am yesterday because of a lack of staff. The fatal accident at the entrance to the hospital happened at 3.45pm after a white Holden Barina hatchback, in which the three women were travelling, and a white Holden Rodeo collided. The 97-year-old woman, who died in the crash, had been receiving treatment at the hospital. The 50-year-old female driver of the Barina was transported by ambulance to Redcliffe Hospital. The 77-year-old seriously injured passenger in the Barina was airlifted to Royal Brisbane Hospital.

Last night The Courier-Mail was advised it took an ambulance 44 minutes to transport the injured female driver to Redcliffe. But it is believed the woman, suffering from head injuries, broken ribs, and chest injuries, requires a high-dependency bed not available at Redcliffe Hospital, and will have to be transferred to either the Royal Brisbane or Princess Alexandra Hospital.

Australian Medical Association Queensland president Dr Steve Hambleton said he was advised a doctor from the Caboolture Hospital assisted paramedics at the accident. "A tragedy like this drives home the importance of quality services in large communities that are growing fast," Dr Hambleton said. "It may well have been that these people would have needed air transport anyway. "It just highlights how unpredictable our lives are, and the need for quality services." Dr Hambleton said the Queensland Government now had no choice but to "fix" the problems with its public hospitals.

Opposition Leader Lawrence Springborg described the car accident victims as "the tragic human face of government spin". Late yesterday, Acting Premier Anna Bligh announced a temporary deal made with the Mater Hospital to provide doctors so the emergency department could be reopened in coming days. Health Minister Stephen Robertson insisted the two patients injured outside Caboolture Hospital had received appropriate care despite the closure. He said the woman transported to Redcliffe had received immediate attention from paramedics, and the person airlifted to Brisbane would not have been treated in Caboolture because of the nature and extent of her injuries.

But Caboolture's former emergency department director Sylvia Andrew-Starkey said the woman "would have been stabilised at Caboolture" if the department had been operational....

Mr Robertson yesterday admitted the Caboolture Emergency Department "is, in fact, closed" after claiming since late last year it would remain open and services would simply be scaled back. He said five people had presented at the hospital yesterday. Three had been told to go to a GP, despite Mr Robertson's claim earlier this month that "no one's going to be turned away". Despite previously insisting that the department would be staffed by a senior doctor during the day and a junior doctor at night, Mr Robertson admitted there had been no emergency doctor present to see the other two patients.

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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