Bush Has Pharmacy Discount Card Plan
Prescription Drug Benefit Is Part of Medicare Revamp
By Amy Goldstein
Washington Post Staff Writer
Wednesday, July 11, 2001; Page A01
The White House is devising a plan
that will offer pharmacy discount cards to all older Americans by the beginning of next year in a new strategy intended to
provide the elderly quick help on prescription drug costs.
President Bush is to announce the pharmacy discounts tomorrow
as he also lays out a set of principles that the administration hopes will guide Congress in revamping Medicare, the nation's
health insurance program for the elderly. The principles will include adding a separate, subsidized prescription drug benefit.
According to sources familiar with the pharmacy discount plan, the administration is designing a national version
of an approach, adopted recently by some private insurers, that relies on companies that manage drug benefits to buy prescription
drugs in bulk. The companies would sell cards to Medicare patients, who could use them at any pharmacy to purchase their medicine
at a reduced rate.
The sources said the White House believes the program would not require congressional approval
and could be implemented by the Department of Health and Human Services within several months.
By announcing the
drug discounts, the administration is striving to simultaneously bolster the affordability of medicine for patients who need
it most and to address a health care issue of acute public concern that played a prominent role in last year's campaign.
The discount cards represent the second idea for curbing drug expenses of the elderly that the administration has come
up with during the six months Bush has been in office. The first idea, based on a Bush campaign proposal known as Immediate
Helping Hand, would have created a temporary block grant to help states subsidize drug costs for their poor, elderly residents.
It was rejected swiftly on Capitol Hill.
With the new plan, the administration can position itself as taking the
lead on prescription drugs -- the most popular aspect of Medicare reform -- regardless of whether Congress acts on the issue.
The idea relies on the market-based approach the administration favors, and would fall short of the subsidized prescription
drug benefit for all Medicare recipients favored by most Democrats. Sources said that the government would not dictate the
size of the discount elderly patients could receive. They also said the plan would not require federal money.
its private-sector orientation, the discount plan dovetails with the principles that Bush is preparing to set forth for a
more fundamental restructuring of the 1960s-era Medicare system that is one of the nation's largest and most popular entitlement
The president is scheduled to outline more than half a dozen principles publicly tomorrow morning, after
he briefs a group of senators and House members.
The principles include creating more options for people in Medicare,
probably by increasing reliance on private insurers to cover patients who are 65 and older. The president will say Medicare
should do a better job covering preventive health care. And responding to complaints from doctors, insurers and hospitals,
the president will recommend easing some of the program's regulatory requirements.
Bush also will say he wants the
program to begin including voluntary prescription drug coverage, apart from the discount cards. He has not said lately what
that coverage should include, but during last year's campaign, he proposed that the government pay the entire monthly premiums
for eldery Americans with relatively low incomes and at least one-fourth of the premiums for other Medicare patients. He also
proposed that Medicare pick up coverage for a small number of older people whose drug expenditures exceed $6,000 a year.
The strategy of outlining principles resembles one the administration used in efforts to create federal protections for
Americans in managed care, when Bush last winter defined a set of broad objectives but did not craft his own detailed proposal.
Instead, the president has latched onto a bill that failed in the Senate and one that is pending in the House that he has
said meets his goals.
The president is stepping more firmly into the Medicare debate as Congress prepares a new round
of deliberations on how to modernize the system and prevent it from running out of money once the large baby boom generation
retires. Efforts at such changes have suffered in recent years because of partisan disputes.
This time, Senate Finance
Committee Chairman Max Baucus (D-Mont.) has said he wants the panel to act on a Medicare proposal by the end of this month,
but aides are struggling to weave together two rival bills -- one sponsored by Sen. Bob Graham (D-Fla.) and the other by Sens.
John Breaux (D-La.) and Bill Frist (R-Tenn.). Their proposals differ in how generous prescription drug coverage would be,
how much money would be required and how far the Medicare program should be tilted into the hands of private insurers.
Senate staffers familiar with Medicare said it is unclear whether the differences can be resolved in time for the committee
to act before Congress's August recess.
As the Medicare issue intensifies, Health and Human Services Secretary Tommy
G. Thompson yesterday blocked a different attempt to cope with drug costs, approved by Congress last year. It would have enabled
American consumers to buy drugs that were manufactured in the United States, sold to countries in which drug prices are controlled,
then imported back into this country. Reaffirming a decision reached late last year by then-HHS Secretary Donna E. Shalala,
Thompson told Congress that, under such an arrangement, the safety of the drug supply could not be guaranteed.
© 2001 The Washington Post Company
HMO Execs Rake in Cash
Study Says HMO CEOs Are Making Big Bucks, Amid Massive Benefit Cutbacks
By Linda Douglass
June 20 Many of the top executives in the managed care industry were paid huge compensation packages last
year according to a consumer report obtained by ABCNEWS, and the 10 highest paid executives raked in an average of $11.7 million
Some managed care executives also got stock options last year: Ten executives hold an
average of $68 million in stock options apiece.
At the same time, patients in many of those health plans are being denied
coverage, and the frustration level for millions of people is rising.
The report was compiled by a consumer group,
Families USA, a critic of HMO cost-cutting.
"It puts the issue of cost in perspective," says Ron Pollack,
executive director of Families USA. "It shows that the companies are not that concerned about costs when it lines their
New From The Post
Senators Agree to Bill Compromise
Key senators announced a bipartisan compromise to limit health-care
lawsuits against employers today as a Republican amendment to shield small business owners failed. By Helen Dewar
Index Predicts Hospitalized Seniors' 1-Year Survival
BETHESDA, MD, 26 June 2001 An elderly patient's likelihood
of living one full year after discharge from a hospital can be accurately assessed using six prognostic indicators, say researchers.
For a patient 70 years or older who is hospitalized for medical, not surgical, reasons, the researchers determined
that the risk of dying within 12 months of discharge is influenced by the following factors: dependence on another person
for performing basic activities such as dressing oneself; the presence of cancer, congestive heart failure, a serum creatinine
concentration of >3.0 mg/dL, and a low albumin level; and the patients sex.
Other factors, including age greater
than 80 years, a history of myocardial infarction or dementia, and discharge to a nursing home or skilled-nursing facility,
were also associated with an increased likelihood of death during the year after discharge from the hospital. But once the
six main factors were taken into account, these other indicators did not influence patients survival.
were reported in the June 20 Journal of the American Medical Association (JAMA).
The study involved two groups of
patients 70 years or older. The first group, with 1,495 patients, provided information that was used to develop the prognostic
index. A second group, with 1,427 patients, later provided data that was used to independently test the index. In all, 492
people in the first group and 398 in the second group died during the one-year follow-up periods.
Using a point-based
system, the researchers divided the seniors into four risk groups. The one-year death rates ranged from 413 percent in the
lowest risk group (0 or 1 point) to 6468 percent in the highest risk group (620 points).
A diagnosis of metastatic
cancer added 8 risk points to a patients prognostic score; nonmetastatic cancer added 3 points. The inability of an elderly
patient to bathe, dress, use the toilet, move from a bed to a chair, and eat without the assistance of another person added
5 points. The other risk factors, including male sex, added 1 or 2 points to a patients total score.
The point system
was able, 7579 percent of the time, to correctly discriminate between a patient who would die within one year of hospital
discharge and a person who would live. The researchers said tests that focus only on physiologic or disease factors have a
lower sensitivity, 5968 percent.
An editorial (PDF) in the same issue of JAMA was mostly supportive of the prognostic
index, describing it as a way to "help physicians validate their clinical impressions." The editorialists also suggested
that use of the index might dissuade clinicians from heavily relying on age as a predictor of an elderly patient's short-term
Despite the potential usefulness of the prognostic index, the editorialists were skeptical that the system
would be widely used in clinical practice. The index, they said, is freely available and not promoted through paid advertisements,
increasing the likelihood that many clinicians "will never hear about it."