Fri Jun 23, 2006
Medicare and "Why Conservatives Can't Govern" by Alan Wolfe
Anyway back to our regularly scheduled program. I've had a couple posts on Medicare - which has turned my fathers small business into a vertiable non-profit. He's making much less on each transaction - and the insurance and drug companies are making more. The conservatives in power left out the small business people in the new Medicare plan it seems. It's made a huge impact on his bottom line - to get the patients on new plans the work load becametwice what is was before.
Since January it has become less work to deal with the program, the biggest amount of work in dealing with the new plan is over. But even so, he says for each Medicare transaction he is making even less money than before. So little it doesn't even make sense.
The Wal Marts and the mega stores can absorb this - both the time and the money. I saw a sign in a big mega store with a pharmacy that college pharmacy interns would be available to help seniors choose a Drug plan. For a large store with a number of Pharmacists and technicians on staff, the extra work can be absorbed.. And the diminished return on the sale. But for a small store, with 2 or 3 employees, a great influx of time in dealing with this, and a decrease in profitability on each item, it hurts them so much worse..
And the ironic thing is that when the government imposes a more complicated system and limits the amount of money that can be made, it sounds like some kind of 'liberal' do-gooders imposed some regulatory bureacracy. But no, the complexity of the current system comes from the conservatives just letting the insurance companies write the new Medicare system.
The insurance companies and the drug companies make more.
The small town pharmacy makes less.
Pretty soon there will be no more small town drug stores, just giant Wal-Marts, and all the money you spend will not go back into the economy, destroyed small towns with their best chances of an economy are to pick up tourism dollar in recreating the glory of the American small town yesteryear.
Is this the laissez faire free market, or a new bureaucracy written by various big business lobbies in collusion with their so called 'family values' conservative who would just as soon see Wal-Marts and Dollar stores take over every small town?
In the following essay by Alan Wolfe in the Washington Monthly, "Why Conservatives Can't Govern", he argues that conservative have an inherent contradiction in governing and making public policy.
Anyway, it's a great read, and here's a quote from it about Medicare:
The question of whether Medicare reform will prove politically fruitful for Republicans is still open. But the question of whether it has proven to be an administrative nightmare is not. There were two paths open to Republicans if they had been interested in creating an administratively coherent system of paying for the prescription drugs of the elderly. One was to give the elderly nothing and insist that every person assume the full cost of his or her medication. The other was to have government assume responsibility for the costs of those drugs.
But Republicans were just as unwilling to design a sensible program as they were unable to eliminate the existing one. To prove their faith in the market, they gave people choices, when what they wanted was predictability. To pay off the pharmaceutical industry, they refused to allow government to negotiate drug prices downward, thereby vastly inflating the program's costs. To make sure government agencies didn't administer the benefit, they lured in insurance companies with massive subsidies and imposed almost no rules on what benefits they could and could not offer. The lack of rules led to a frustrating chaos of choices. And the extra costs had to be made up by carving out a so-called "doughnut hole" in which the elderly, after having their drug purchases subsidized up to a certain point, would suddenly find themselves without federal assistance at all, only to have their drugs subsidized once again at a later point. Caught between the market and the state, Republicans picked the worst features of each. No single human being could have designed a program as unwieldy as this one. It took the combined efforts of every faction in today's conservative movement to produce a public policy so removed from common sense.
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