Focus 580; Medicare Update

Will these days on Capitol Hill. It seems that the number one domestic policy issue at least the thing that everybody is talking about is Social Security. And the reason everyone is talking about it is that President Bush seems to have put it at the top or certainly near the top of his domestic policy agenda for his second term. And I'm sure by now you have heard that the president argues that the system is in serious trouble and that if nothing is done that in not very many years into the future the system's going to run out of money it's not going to be able to pay the benefits of retirees. Now it is also true that people in Washington disagree with ant that the Congressional Budget Office and the actuaries of Social Security say no that that's actually not true. That one says the system will be solvent until 2042 another says 2052 and then they say oh well after that no we can't pay full benefits but we can pay say three quarters of the benefits. So at any rate that's something people are talking about a good deal these days however others in Washington say you know

maybe Social Security does have some problems but there is a much bigger crisis and looming with another program that takes care of the needs of seniors and also some people who are disabled and then. It is Medicare and that is what will try and spend some time talking about it here this morning in this first part of the show. It is said by the Medicare program's trustees that Medicare is likely to run out of money if nothing changes by the year 2019 much sooner than people are talking about for Social Security in doctors bills they save Medicare expenditures will exceed those of Social Security by 20 24 so that's only 19 years. And they say that the cost of Medicare will double those of Social Security by 20. Seventy eight just last year a year before the president signed into law a proposal that would try to provide some help to people on Medicare with their prescription drug costs and this morning we'll try to talk a little bit about what people are

thing thinking in Washington when it comes to Medicare and other potential changes and our guest for the program is Mary Agnes Carey she is a senior writer with Congressional Quarterly. It's a publication or really a kind of a series of publications all devoted to covering what goes on in Congress and on Capitol Hill. And they have more than a hundred reporters editors and researchers full time spending following the Congress and following legislation in print and also online. So if you're interested you can seek out the publication and of course here this morning Quest. Ns r r welcome 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5 Ms Kari Hello. Hi thank you very much for joining us once again. Thank you for inviting me. Well we certainly appreciate you giving us your time. Well I guess what I would like to do first is to talk a little bit about the program to provide some coverage of prescription drug costs. We've talked

a couple of times about this and going back to one thing that we discussed the last time we talked which I think was August I think it was and President Bush signed this into law near the end of 2003 and it goes into effect next year. And when what to try to provide people some some assistance with drug costs in the interim they came up with this plan of these prescription drug discount cards that people could could go out and sign up for. And one of the things that we talked about last time in the time before that was that the number of people who were signing up for these cards was much smaller than had been expected. And the explanation apparently was that a lot of people found it very confusing to figure out OK how do I do this and how do I decide that card is for me rather than car. Word B C D or or whatever. And I guess I'm wondering has that changed. Have have have many more since last time we talked have a lot more people signed up for this or is that more folks have

signed up. I don't believe that they've hit the numbers that they were hoping for with a prescription drug card but I think if we had some ministration folks in the room they would talk a lot about how some of the there's still a learning curve and folks can still sign up for these cards at full drug benefit doesn't begin as you know till next January 2006 so the numbers have been improving. But I think for the government it's been an ongoing information process to explain the cards and it's been sort of a window into the world that they'll face this fall in trying to explain to Medicare is more than 40 million elderly and disabled beneficiaries that the options they have for their full drug coverage which is the big bill you just spoke about and that goes into full effect on the first of next year. Well obviously there but their main focus is on the. Program that that goes into effect next year. But if you ask people in the administration or in Congress how do you think that you did with this intermediate program to try to help provide

something in the meantime. Would they say that they felt that it was a success. I think they would. Proponents of I think definitely would because they would say that it was something seniors never had before. It was an ability for them to look at something that could work for them it's sort of a trial run if you will for the Medicare drug benefit because the card is going through the process of the Medicare drug card as you just explained. People would have to look at different programs different companies. Will this work for me. They have to go through their own analytical exercises in the sense of what drugs Am I can do I need how far am I willing to go to a pharmacy that might be less expensive. Am I comfortable getting my prescription drugs by mail order. Does this card cover what I want and how much does it charge and how much does it cover versus another card. Getting seniors into the system to try that and in many ways trying the drug card was sort of a pretty easy thing for folks to do. Despite its complexity it was something where they could just sign up and give

it a try and they could drop it if they didn't want like it. They could decide they didn't want to enroll at all whatever they chose but it sort of gave people a way to get in to looking at the drug benefit and I think that that exercise from the federal official standpoint is a very good exercise. Of course opponents of the Medicare bill and the drug card have looked at the experience the drug card and said look this is this shows you how unpredictable how difficult this is how hard it is for people to figure out it will only be worse when the full benefit goes into effect. So both sides are interpret ing it if you will to their advantage. Well it's my understanding that a couple of weeks ago that the administration. Made public released put out there the rules for this program for this new benefit that's going to go in effect next year. Is that is that really all worked out do we know exactly how it's supposed to work.

Well the logistics of how a insurance company wants to package benefits how they go about offering those how they go about deciding how how providers the physicians that want to participate in the hospitals and so on. That's you know getting processed right now but I think that the implementation is an ongoing process. There had been rumors for example a few months ago that perhaps the full implementation of this drug benefit would have been delayed because the Centers for Medicare Medicaid Services which is known as CNS they're overseeing the whole thing that perhaps the staff couldn't make those deadlines but every time the officials the CMAs have been asked that question the response has been no we're on target we're going to make our deadline and this benefit will go online as promised. So yes some of the parameters are out there. They're subject to comment of course from industry folks and all the advocates for seniors and for the disabled are digesting them asking questions trying to figure them out. But I think it's still a work in progress as we go

forward to next January 1st. Well if we're people who get their health care from some kind of managed care organization like they're in an HMO all their own they're sort of used to the idea that they go to their physician the doctor writes a prescription the doctor probably chooses first from a list of approved drugs for that. The person probably pays some kind of small co-pay. Then there's another list of drugs where they say OK if you really want these you can have them but it's going to cost you more and there maybe isn't another level past that where they say OK if you really really want these it's going to cost you that much more. And that's kind of the way that it works in is it is essentially is what we're talking about a program that operates like that. It certainly could and it would depend on the company the entity that's offering the coverage. There are some standard parameters that a company would have to have to meet if they want to offer a Medicare drug benefit for example the average premium is

$35. The could be it could be higher it could be lower depending on the plan but there are there are rough parameters of coverage that plans have to meet but certainly any health plan could have in it for Medicare prescription drugs or to offer all coverage could offer what you're talking about a tiered co pricing and your pricing rather that has the. Will payments sort of tag to get a generic drug cost you less. If you want the the newest drug on the market it will cost you more. I'm sure that plans that offer drug coverage in Medicare are going to the exact same thing because that's been shown as a way in the under 65 market were where folks are getting their employer coverage that that's been shown as a great way to keep your drug costs down because you're in essence like you said you make people pay more for the highest newest drug. I guess I'm having a little bit of a hard time understanding how how this changes the health care landscape. Essentially in what way is it really so different than it is today.

Well what you're doing is you're saying to the Medicare population basically they've been in a situation where a few folks have gotten their coverage from private plans but most folks have gotten it under Medicare fee for service program which is a very standardized uniform. Same coverage for all. Now we're moving to a system where beneficiaries Medicare beneficiaries could be offered different choices and different options for their coverage. People don't like this idea say this is great. Seniors know how to pick things they know how to pick a car they know how to research and imply and there are a lot of them are Web savvy even though there's documentation to show that a lot of seniors have nothing to do with the Internet. The idea is let's take the Medicare population now and future and give them choices and give them options and in many ways this Medicare drug bill is not written so much. I mean it will benefit current beneficiaries and they if they don't enroll in it by a certain point they'll pay a penalty and there are obstacles there. But I think in many ways it's written for the long

term it's written for a lot of the baby boomers that begin to come into the system in 2010. All these folks that have it in their in their workplace as you mentioned they've already had private health insurance plans and they're used to it and they're used to making choices and I think many of the older Medicare beneficiaries right now may not want anything to do with this idea of trying to pick a plan you may have some of the younger beneficiaries newer folks in the system and folks to come may have a greater greater comfort level. But to the to balance the picture here many Democrats and other opponents of the Medicare drug plan believe that that it they the bigger they oppose a Medicare drug plan but they believe the strength of Medicare as it currently exists is uniformity that you can be assured no matter where you live in the country you will get certain things covered you will have fixed you will have certain co-payments and they're set and you can you can know that and you can take great comfort in it and they are concerned that this variability will confuse seniors and will cut some short on their coverage.

Well I guess that that would be a concern. I can imagine and that I would expect people would have is are we are we truly putting people in a position where they're going to have to be their own advocate and what do we do if there are people who just seem to again seem very confused about the system and how it's designed to work and have a tough time to figure out in in what way they can participate in the in the way that's most advantageous for them. So this is that you've captured absolutely perfectly this is one of the great complexities in trying to put this bill into place. You know CNS officials have tried to they've given grants to local entities to try to educate seniors. They've really tried to work to beef up not only their website but their 800 numbers to have operators that understand this benefit it can talk to you about the benefit or the drug card as it would be now where a lot of activity is. But then you you will read you continuously read reports about well a

particular reporter or a senior called the 800 line and they got the wrong information or they were referred to and cities which were closed at the time and couldn't provide the information when the seniors needed it. And it's very very difficult because you think of all the men it takes in Washington and took a heck of a lot of energy on the Hill to pass the Medicare drug benefit I was there for every minute of it felt like. You look at that but it's just the beginning I mean it's a huge undertaking to pass the law but now to put it to sort of take it to the street and sell it to people or explain it to people is this unbelievable challenge I think it's a massive hurdle that will have to be overcome and it wouldn't surprise me in a few months for a few months of 2006 as the drug benefit starts up. I think you'll read about a lot of kinks and a lot of problems and some folks will love it and think it's great especially I think if you're in an urban area you're going to have a lot of choices for your benefits. They may people may prefer it but I think you're also going to read about there's a population called the dual eligibles. These are folks who

you know qualify for Medicaid and Medicare they'll be getting a coverage under Medicare. There's a. Lot of concern about that population. Will this be confusing to them. What if they've had a drug regimen covered for a particular time and they go on a health plan that doesn't want to cover a particular drug they're on. And how do they appeal it. Do they have the ability to appeal it. How do we help them. These are all these complex considerations and issues that are being worked on now examined. I think you probably have a lot of seniors advocates in your in your audience who work with them who are working their way through their own confusion about the drug benefits. So it's a massive undertaking. I have several callers here and I want to tell those people I get to them in just a second. Don't ask me just one more question have you talk about just for a little bit what sort of estimates have been made on the what. What the additional cost will be to Medicare administering this new program.

Well in typical Washington experience even something you would think a simple as an estimate has become complex. When the bill passed and that was in late 2003 the Congressional Budget Office which is the official scorekeeper for legislation before Congress said that there would cost 400 billion over 10 years. Internal Bush administration estimates which don't technically do not have to be part of the congressional consideration and debate because CBO Congressional Budget Office is the common congressional scorekeeper internal budget Bush administration estimates put the cost at much higher they put the cost at about 540 billion dollars over 10 years and those newer more expensive estimates surface just about a year ago. So that kicked off the debate in Congress member saying look you've got the CBO says 400 billion but they ministration new its own estimates were far higher. And then when you look at why the estimates were different it was based on a variety of assumptions that the different actuaries made about the number of

seniors who would enroll. The number of seniors who might lose their drug coverage from an employer. How plans might how they would handle drug coverage as all these complex things. But the the bottom line here is nobody really knows because you can't tell at this point how many seniors will get in the benefits role in it. There are different estimates over that but that will affect cost. What sorts of drugs are covered what the usage of those drugs are and new drugs that will come on the market that may be in demand that will be blockbusters and will cost more money. So the bottom line here really is nobody knows what the cost will be. But conservatives in Congress have argued there's nowhere to go but up. And they're probably right in many ways. Our guest in this hour is Mary Agnes Carey she's a senior writer with Congressional Quarterly a publication that specializes in covering Washington politics and we're talking about Medicare and questions are welcome we do have several here people here waiting and others are certainly welcome to call we just as people try to be brief just so we can

keep it moving and get in as many people as possible. 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5. Those are the numbers. First caller is a battle line one. I'm wondering what this is going to do to my. Pretty good not excellent but pretty good HMO which pays for prescription drugs which I pay a co-pay on which has this year gone up out of my own pocket somewhere around $600 for a prescription. The pharmacy gave me a run off of what it would have cost if I had to pay it straight forward it which would have been around twenty five hundred dollars. Now I do have Medicare also and will I have to go along with the Medicare are what the HMO going to say because I do have Medicare. Is it going to mean

quire me to get one of these drug cards which sounds very complicated. The drug card is the is the program the interim program that started last summer and will go to the first of next year you don't have to you don't have to have a drug card you can just skip that if you want. This fall you and many other Medicare beneficiaries will get in the mail a list of your options. These are the plans in your area that offer coverage and if your current plan which you like is offering coverage look at over to see how much they're going to charge you what they're going to cover and if you like it you can just stay where you are. Well you get this through a group. This is a University of Illinois through the state. And they negotiate. And I think you know many of us who are employed by the university go along with that and have an HMO and and go along with that program which is negotiated in the state.

But I'm wondering you know this is a pretty good program. Not as good as you might want but it's pretty good. And is it going to get scuttled. I don't think that's necessarily the case. I mean if they want to participate as a medic and provider of Medicare drug coverage which if they have a lot of folks already on the plan my guess is that's the case. This is a guess on my part but my assumption would be that they would want to offer their coverage they will continue to offer their coverage and you could continue to enroll in it but that's a choice that you'll have to make this fall. But I mean my guess would be that you'll be ok just where you are. OK another question then is as I understand it there's a Medicare payment that comes out just like your plan for your doctors and that that will just automatically come out of your Social Security benefits where they currently deduct your premiums. Part B premiums out of that and I that is a very good question my memory

is that that would happen the same even if I didn't participate in the program I don't know if you don't participate if you didn't if you didn't enroll in either a Medicare prescription drug plan or one of these plans that offers that is going to offer drug coverage and everything else it's not going to there would be no extra money taken out of your check I believe it would only be if you chose one of them. OK. So this is just really a very confusing situation and something that was pretty simple for us to handle in the past right. People feel that way other people argue it's a great opportunity for seniors to have choice. They they cite things like someone is on their employer health plan right and then they and then they have to go into Medicare once they've left their employer or they've retired and they don't want the Medicare plan they want their other plan and so it it's really a new frontier there's absolutely no doubt about that and I think as everybody says in Washington all the time the devil's in the details.

You know by the end of 2006 we'll have a better view of how this worked or didn't work but yeah well Congress can always go back and change things they've done it before they did it in 1988 there was a benefit new law called the catastrophic drug act for Medicare and and it basically was in theory put out there to help seniors and Medicare other Medicare beneficiaries with really excessive drug costs. The problem was everybody paid into the system. Right but not everybody benefited by it. And people went nuts you may remember the big visual on this was senior stopping Dan Rostenkowski who was then head of the Ways and Means Committee and being on his car and demanding action on this and it reverberated to the point where on the Hill they just repealed the bill. You know remember that. Yes. So it was going to be means testing is that going to be again so that we're going to get taxed on something on our income tax when what they're talking about the one the one thing they've done in this bill is they they did something called income

relating which is technically a little different from Means testing they're basically saying the government contribution would change based on your income and the income levels for that are fairly high for the government contribution to drop. But the the bigger policy implication in my opinion is the government has opened the door to link Medicare benefits to income and we've never done that before. So while now the threshold is fairly high and forgive me I can't remember the number on top of my head but that threshold is high for now. But if expenditures continue to climb which everyone thinks they will not only just for the Medicare drug benefit but for Medicare in its totality and as you have millions of folks begin to go into Medicare starting at 2010 which is when the baby boomers really kick in going in there's nothing. To stop folks on Capitol Hill from saying well we're going to lower that income cap and lower it a bit more and it will be politically controversial if they do that but they have sort of opened the door to it and that may be I think in the eyes of some

policy folks the only way to control entitlement costs down the road is to link them more to income being the more you've made the less you'll get in a government out of city. But the more you make as you get older is what you're taking from your retirement savings those who are three you know. Right. And so that's the only reason you're here more income. And as you get older and then you're really giving it all away. Yeah I mean I think what we're just going to have to see how they handle that. But there has been a nod to it if you will in the drug benefit plan and believe me it will be. You'll hear a lot about it if they start doing that. I will certainly will say a lot about myself. OK. Mary Matalin thanks for the call and we'll go on here next caller. In Champaign County a line too. Oh yeah I called about a sort of a big picture question but on this last issue I think the woman is right to worry about. Maybe maybe not. And educational institutions deciding that health care and costs of prescription drugs are

outside of its core mission or something like that. But a lot of people are worried that corporations will pass off that part of whatever health insurance they are currently paying to this program and in undermining some coverage that is already a job linked or something like that. Yeah I think you talk about the concern that employers will drop their Medicare retiree drug coverage right about I think the government and you know it would have to worry about it right. What they've done in the bill to try to circumvent that is they want to offer the employers a subsidy for them to continue offering coverage because they don't want the government really doesn't want drug make a big part employers to stop offering coverage because it will only drive drive the government's bill up. So they've offered companies a subsidy incentive. They've also said that a company could become a prescription drug plan could become a health plan in the sense of offering their retirees as they do now drug coverage and their health insurance

benefits so. So they would qualify to be part of the right have it all a fighter own card or something exactly. So whether or not companies deem the amount of money they're going to receive if enough is yet to be seen and of course as health care if health care costs continue to climb they may decide even though we're getting a subsidy it's just not worth it to us. So that'll be part of the ongoing equation and pressures that will have to watch as this thing goes forward. My other thing that was elicited from what you were saying was you went really lightly over this cost estimate for the Medicare OK. That was that was a fraud there's somebody that's being prosecuted and there's a contempt of Congress where somebody knowingly produced the wrong figures and you know up until it was passed so I mean one can't just casually say that well there's some argument about the about a way to see only the promise of your future saying the only thing I mean it.

I did. Only one over quickly because some people find that extremely boring. Well I think fraud to get something in the past is a is a very pertinent issue I mean considering how many times it's happening to say here's the deal that Congress has to change its rules because congressional rules now say the agency that makes an estimate is the Congressional Budget Office. That's the out if you will that people are using who wanted this bill passed to cover themselves. They say no no no we didn't keep him from Congress. In essence they're not they're not required to. The thing that has to happen on the Hill to Depp definitely Democrats have made arguments about this and they've talked about it even conservative Republicans have been outraged about this you're absolutely right. But what to say makes it different for the future. If they would have to basically change congressional rules and say no no no it's not just the Congressional Budget Office. We have members of Congress must have a guarantee that if there's an internal administration estimate that that's part of the mix. And right now it necessarily isn't that CBO is used as the official

barometer. But. You could argue that that's not enough clarity and I would say. From from going on forward now when there are bills like this that come up even though an administration whoever is in there may not want to make a higher estimate or even a lower estimate public. I would think you'd have many more members now in the Senate and the House saying look we need all this information that you have internally. And I'm I think part of the reason they haven't passed a rule change on this is because the Republican Party doesn't want to happen. But that's something that if you got to that kind of level minutia procedurally it would change the debate on a lot of these bills. I want to jump in here I hope the call will forgive me but we're past our midpoint here already and I have another call I want to get to you and also we need to do so again our guest for anyone who has tuned in the last 10 minutes perhaps. We're talking this morning with Mary Agnes Carey she is a senior writer for Congressional Quarterly publication that. Long time has been following events on Capitol Hill and it's available in print and online so if you're interested in

reading about legislation and the some of the some of the tortured paths of the goes through you can seek out the publication of course questions here welcome to 3 3 3 9 4 5 5 Would you also have a toll free line good anywhere that you can hear us. 800 to 2 2 9 4 5 5. Our next caller is in Champaign and on line 3. Hello young. This is the this is the real fiscal problem. It's shameful to not talking more about it. You said that the devil's in the details but details on Washington therefore the devil was in Washington I suppose. I got two quick questions now hang up. One is a couple of weeks ago there was a peculiar little article in the local paper about a. Company here an insurance company offering some sort of. It sounded like supplemental Medicare insurance but they called it an

alternative to Medicare. And so I was wondering first if there's something happening in that area other than supplemental insurance. And then number two is this is going to be such a big problem in the future I was wondering I'm particularly worried about the things they'll cut back on. And I was wondering if you could if you had any idea of what's happening in the in the particular issue of transplants you know are they thinking to limit those and I'll hang up and listen thank you. OK. The first question if it. If it sounds to me that that's like that if a company trying to get in the game earlier saying an alternative to Medicare they probably mean an alternative to Medicare as you call fee for service. It probably is some insurance company or a company that's trying to offer Medicare drug coverage plus your health coverage in one package but without saying there are

materials I couldn't quite tell you that I don't know of any. Anything going on to limit coverage of transplants anyway and you may no Medicaid actually other than Medicare covers a lot more of those transplant procedures than Medicare does to cover that we actually get Medicaid rather covers a very large share of the transplants done all over the country. So I don't know of any any move on that at all. OK let's talk with someone else in this caller's in Urbana. Lie number one below which is in shrimping County believes now that it's kind of unfair No I'm sorry I am not going to do that. We do have time for other callers here we have about 20 minutes left in the show. If there are some other callers who have not been on once already and would like to call in you're certainly welcome to do that the number here on Champaign Urbana 3 3 3 9 4 5 5 and toll free 800 to 2 2 9 4 5. I don't want to get to something a

little bit bigger and it may be a little bit more difficult to talk about and that is does have to do with the larger issue of the growing cost of Medicare not just in terms of providing prescription drug coverage and I think that a lot of people as some of the callers have have referenced to say that yes you know because now we're talking about Social Security they're going to say yes maybe Social Security has problems but if you take a look at this longer range issue of how it is we're going to pay for rising costs in the future. Medicare is much bigger and then I think there are a lot of people are saying the next big thing has to be Medicare. Right. What what exactly are people thinking and are and how are they talking about this these days. Well you've got someone like David Walker who is the General Accounting Office right who's out there and they they do all sorts of people read about something called a geo report. G.A. Oh look at this government spending that government spending. They're out there sort of a you know from that watchdog group but. People are talking about the unsustainability

of what we have. And part of the reason that some Republican conservatives didn't want the drug bill passed last year is they say it was tagged a cost. They're worried about the cost and as more baby boomers get into the system again this is 2010. Point where people are looking at the numbers of Medicare beneficiaries climbing that there's a debate I think it's going to come down to can we as a nation or do we as a nation want to continue to offer what we've offered. And you'll see it you mentioned Social Security at the top of the program. President when I was way at STATE OF THE UNION to say if you are I think you said 55 years old or older you've got nothing to worry about which is defined that they're looking at the younger populations and the growth in that younger population when they go into the programs as where the spending bubble will be if you will so that you know right now a lot of the debate on Medicare is if it is around a lot of the focus rather I should

say a lot of it is around the drug benefit of people who don't like the drug benefit want to get it repealed. People that like the drug benefit are talking up its values and its greatness and how people should enroll and that's a lot of the debate here and getting it online but the longer bigger question is what do we want Medicare to be. And if they be watching how the drug benefits unfold will be critical because if it doesn't do well or people don't like it or seniors are extremely uncomfortable with trying to pick between these plans which is something a part of the bill predicts what happens then that may be a signal to Washington and to lawmakers. Look people like the uniformity of the current Medicare program they didn't want to change. And you're just going to have to deal with this influx of additional people. So I think to me that's what in my mind philosophically what the debate will come down to be do what we want to cover. Can we afford to do what we've been doing. Do we need to do it differently and how ready. The public to accept that or will they

reject it and want to go back to you know when I get Medicare it's been you know a program for years and years and years you know since 1965 I mean we've had 40 years of it and people many people have you know the satisfaction is extremely high. People like it they have a comfort level with it and what will happen when with the drug benefit and you know people will be picking and will they decide to stay in fee for service. Well the enrollment figures be anywhere close to what they want I mean those are all the things we need to watch. Well again we have about 15 minutes left in this part of focus 580 Our guest is Mary Agnes Carey she's a senior writer with Congressional Quarterly we're talking about Medicare. And we have spent a good deal of time talking about the Medicare prescription drug program that will be going into effect in January of next year at the beginning of next year. But also perhaps as something of the of the larger issues involved with the cost overall the system and how do we continue to meet those costs as we know that the cost

of delivering health care seems to be going up all the time and the potential number of people who are going to be needing health care is going to go up to 3 3 3 9 4 5 5 toll free 800 to 2. 2 1 4 5 5. Something else I did that I came across and I guess I must have missed this myself. Maybe it didn't get a whole lot of coverage is that as a part of that the Medicare prescription drug legislation there also is a provision that promotes health savings accounts which is something that the the president I think has been interested in for some time. Generally they're I think their philosophy is you know the less the government is involved in health care the better. And what they're wanting to do is to move it more. And also it seems that what they want to do is decouple health care from employment which is the way generally people now have some kind of health insurance that's how they get it they get it through their through their work. And it seems that this is something that this is

in trying to get ready to talk with you this morning and looking at some articles that were published just within the last couple of weeks. This is this is the first I've seen this. Well it is very interesting the Health Savings Account piece of the Medicare bill was added to the Medicare bill pretty late in the game. It's been an idea that was kicked around out there but it was added I think to get a lot of conservatives on the bill because they like the very ideas you're talking about. The idea of having of having individuals more responsible for their health care behind an HSA basically you're getting coverage of a high deductible account. But you can put money high deductible policy rather that you need to meet but you can put money to help meet those to financial parameters of the policy you can put that in-text free into a savings account so the thought is that people will be so cautious and they'll be watching what they're spending and watching what things cost because it will no longer be. You may not have a policy for example that has a $10 co-payment every time you go to a

doctor you may be required to pay more and you have to pay more before coverage kicks in. So you'll be more judicious with your spending. That helped pass the bill basically in the House of Representatives. There were people that voted for the Medicare drug bill not because they really like the Medicare drug benefit because they like the health savings accounts. And it goes to the president's concept of the ownership society. But the Course there you know there's a lot of criticism about these accounts. They there's public health concerns for example will people not do all the preventative care measures they would do otherwise that would be covered by your health plan. And will they create a patchwork of care where certain things are covered in one place but you can't get the option of a plan to have them covered somewhere else and and some people just feel like this will undermine the employer provided you know the employer provided health care system which is what you're talking about. It you know it's something it's millions and millions of Americans get there. Most of Americans like

85 percent get their health care through their employer. So that's another sort of social experiment that will be watching and keeping your eyes on because the Republican Party for a long time has sort of spoken to these issues and more market based solutions on health care. And now if you will the rubber's hitting the road you know how many folks will sign up for the health savings accounts. How do they work. They may be very attractive to employers because chances are offering health savings accounts your workers is a lot cheaper than offering them a traditional insurance plan. And since you get your insurance at work if your employer if your only option is a health savings account then that's what you're going to be in because if you went out outside of your employer and tried to buy a traditional health insurance plan on the open market you would pay a tremendous amount of money for it. So you're right it's a very interesting point. It's a very interesting thing to watch to see how these things work and do they deliver as promised. Well let's go on some of the callers we have someone in Indiana here. And number four.

Hello hello. This is not a criticism of your guest or you either Dave but the times you've had these people on you know she's finally started talk about the rubber hits the road well my robber's been on the road. And this is a you know I'm not an unintelligent fellow and this is one of the most confusing things presented to a person you know how many cards are out there available. You know how difficult it is to find out if the medicines you take are on any of the cards. I mean it's incredible it's like they they passed it and they said well except you overly people to figure this crap out. I went to CBS and they disorder told me go out the door unless I spin the word Twenty five hundred a year and then I found out that after you spend so much money there is a huge space between I think it's tween 2000 and 6000 when you pay yourself completely nobody helps you out yet that's think half of the benefit right. And I talked to late the hospital and she's got little ladies dying because they can't come up with monies to cover this from two to four thousand or whatever it is.

I mean I know most of this is anecdotal but Dave I'd like for you to get somebody on it's you know 65 or older. It's been through the thing and knows what the hell is going on. Well that was kind of kind of the reason that we chose the guest that we had because she had she spends almost full time following issues like this so well know she and I can speak about this from person. Experience that's true but that that was the reason that we when we have had now this is the third time she's been really good about giving us her time this is the third time that she's been on the show to try to talk about this because obviously it is confusing that there are a lot of people that we have a really tough time trying to sort it all out. Classic caller did you sign up for a drug card or no. He he he went off. I don't know because I think that this is the this is what you try to quantify as a reporter and you try to find this stuff out. How many the number that you almost can never know is how many people thought about doing a drug card it had the same experience that your caller just had and said forget it gave up. And then how many of

those folks when they get their information in their mailbox about the drug the drug benefit the choices will say look this is a bunch of gobbledygook I don't want to think to do it would do with it. And I think about everything he said is absolutely right. And it's very confusing for a lot of people. Of course every time I go to a news conferences sponsored by the Department of Health and Human Services they'll get up they'll have seniors on their talk about this drug card is great. And it saves me a thousand dollars and it's the best thing in the world and fraud. The administration's perspective that's what you're going to hear. But the voices of folks like what you just had are just as strong and just as powerful and should be heard and I hope that that gentleman and his friends are calling their representative or calling their senator or making their voices heard as well and that's the sort of stuff that we're going to be watching a lot of hearing a lot about over the next year. Let's talk to somebody in Charleston there next in line three. Hello. I just came on late so I'm not sure this is directly on target.

But with all the emphasis now on privatizing Social Security I'm just wondering what evidence there is that young employees young workers actually are good at saving. I remember when I was in my 20s and. And you work from paycheck to paycheck because there's no money left over at the end. So if we privatized Social Security accounts to me it seems to me that first of all it seems to me that could be problematic I don't believe that that 20 somethings are into thinking about retirement thinking about. Those sorts of issues I was certainly wasn't Most folks that I knew or not we were concerned with today and secondarily I would really like it if this administration started making policy decisions based upon evidence not based on ideology. So what evidence is there that young workers actually are good at saving. They did they would take a certain amount of money each and every single month and put that away

toward retirement and and those sorts of things. Is there any evidence to indicate that. I don't know of any. I I have not researched that and I don't. I don't know a thing about it I apologize. Thank you. All right well let's go to a cell phone caller here next line one. Hello. Hello. I want it and wanted to make a comment about the HSA accounts. I'm I'm a health care consumer but I'm also a health care provider and I have an HSA account. It's true that when it has a high deductible a $5000 deductible and I've even fallen for myself and as I have become more conscientious consumer because that first 5000 comes out of my pocket and as a as it provided I had seen many many abuses of the federal Medicare system in that I'd seen 24 year old patients whose the only medicine medicine they're on is Prozac on permanent

disability for Medicare and 45 and 55 year old men who are in better shape than I am on permanent disability for something that happened a long time ago. I think there's a lot of abuses in the governmental system and I think if they are privatized more of it people become more responsible. That's certainly one viewpoint that I think you've captured eloquently the position of the proponents of these health savings accounts and I think the question's going to be how do people you know use and do they like them. And will there be cases of people who ignored certain medical care they should have had because they decided they didn't want to spend the money or they should have spent the money or whatever so I think that there should be people all over the map people going to like I'm like your caller just talked about and some people will dislike them we'll just have to see how it works out. Let's go to I think the last call another caller here this is someone listening in Moultrie County it's Lie number two. Hello good morning. Yes.

Likewise your comment is that I bought one of those cards. What I want my driver's direction through the last day I can tell it like you want to go with the counter that I can use my help as well as the paperwork involved. God I want you. Well I'm going to buy for those like you. Thank you. Well that's certainly again another excellent anecdotal evidence of how the rubber hitting the road as your previous caller talked about and that this is an example of you've got beneficiaries who love this thing and you got beneficiaries who say I don't like it. I've been struck by the number of comments I've gotten last time on this program of what the pharmacists and the nurses and the doctors are telling their patients or their customers about the drug card I think that's striking because if you're a pharmacist and you feel that that's your burden as the caller just talked about for missing us all this paperwork and gives you a cheaper over-the-counter that's not going to help the administration have successful drug benefit if you don't have other

folks on board so that's also a whole nother dynamic that's going to happen if this thing goes forward. Yeah we're coming down the point here we have just a couple of minutes left and I guess I'm just curious is is there anything else that is still a little bit under the radar that you know about because you spend all of your time on Capitol Hill and talking to people in Congress and you knew know what's what's being discussed. Anything that really isn't getting a whole lot of coverage. That you think soon is going to be I think one thing that it's separate from the Medicare drug benefit but I think there's going to be a lot of examination here of the Medicaid program. Medicaid is best shared state federal health insurance program for the poor and disabled. And it has become a huge cost for many state budgets in some states it's second behind education. The federal government wants to reduce its financial burden when it comes to Medicaid. A lot of state governors feel their Medicaid costs are escalating and they don't want the federal money

to diminish. So this will be a big debate on the Hill in part because the federal government wants to cut the Bush administration wants to cut the budget deficit. So they're looking for savings everywhere. And the president's budget comes out next week looking at how much they're going to ask for Medicaid savings how much from Medicare they may want the Medicare program to reduce the amount of money it pays to hospitals and some other providers physicians I don't think are going to be reduced because they were going to get cut anyway in 2006 and that's a technical formula I think they're going to fix but I think looking at how the government cost savings the government wants to get out of Medicaid and Medicare is going to be a very big story that has not got a lot of information a lot of press right now. Well we're going to have to leave that because we've come to the end of the time I want thank you very much once again for giving us your time. We appreciate it. Sure you're welcome. Our guest Mary Agnes Carey she's a senior writer with Congressional Quarterly. It's a publication that exist in print and online if you're

interested in following the legislation as it works its way through Congress that's a good place to go.