Conference Delegates Challenge Bush Solutions
By Jim Forsyth

The White House Conference on Aging makes recommendations for policy on Senior issues and is usually held every five years. It is keyed to the reauthorization of the Older Americans Act

The 2005 conference, to which I was appointed a delegate by Congressmember Pete Stark, was run by the Bush Administration and the speakers and orientation reflected the views of pharmaceutical and insurance companies, which subsidized the event. Not surprisingly, we heard a lot about volunteerism and technology as the direction for policy as well as the usual incremental advances. There was almost no mention of Social Security, while Medicare spending was characterized as "out-of-control." Ironically, Part D was touted as a boon to seniors, despite its huge price tag and dubious benefits.

However, when the delegates got a chance in the breakout sessions, they roundly criticized the drug benefit. A proposal to amend Part D to include a comprehensive drug formulary under Medicare with negotiated lower prices, as in the Veterans Administration, passed in the Medicare group overwhelmingly, and was cheered when brought to the floor. The point was also made, to general agreement, that Medicare's high spending was not due to deficiencies in the program but rather to our dysfunctional healthcare system. Some of the delegates argued that a single payer system, "Medicare for all," such as Congressmember John Conyer's H.R. 676, is the solution.

I left the Conference feeling the delegates, including many Republicans, are way ahead of the politicians.

Feds Threaten to Cut Funding for ACMC over Psych Care

Inspectors from the State Department of Health Services cited John George Psychiatric Pavilion for inadequate patient care in a December 29, 2005 letter to the Medical Center, which operates the 80 bed facility. The deficiencies are so severe that the Centers for Medicare and Medicaid Services is threatening to terminate its contract with ACMC, which would mean the loss of tens of millions of dollars.

The problems occurred before Wright Lassiter III became CEO of the Medical Center, and can be traced back to Cambio, the consultants who failed to fix the problems at John George. Cambio's failure to fill vacant nursing positions led to a chronic shortage and a dependence on temporary nurses who often lacked experience working with acute psychiatric patients.

The Oakland Tribune ran a number of stories and an editorial about the situation at John George. Go to the website, www.insidebayarea.com, and search for stories by Rebecca Vesely.

Community Clinics Act to Address "Part D" Problems

Over 160,000 Alameda County residents are covered by Medicare, and many of them are struggling with the mess created by the new prescription program called Part D (punsters joke that 'D' stands for 'disaster'). The over 40,000 patients who are "dual eligibles," which means they receive Medi-Cal in addition to Medicare, were automatically enrolled by the feds in various prescription drug plans (PDPs) without any attention to their specific drug needs. Having lost their Medi-Cal drug coverage, patients are showing up at their usual pharmacy expecting to get a drug refill and suddenly discover that they are no longer covered for that prescription or that their pharmacy isn't contracted with their PDP, requiring them to go elsewhere.

Our allies at the Alameda Health Consortium's Lifelong Medical Care have stepped up to the plate with their East Bay Benefits Initiative. Based at the Over 60 clinic in Berkeley, two staff have been providing technical assistance and training to help clinics work with their patients to determine which prescription drug plan best fits their individual needs and which pharmacies they can use with their plan.

Many patients need individualized assistance, and this task has been made much more difficult by problems at the federal level. For example, the Medicare website was supposed to have a tool called the "plan finder" up by the first of October, but it wasn't functional until mid-November, reducing the number of patients who could be helped to find which plan would work best for them prior to Jan. 1, 2006. Nor is Medicare set up to deal with non-English speakers.

Medicare requires that Part D PDPs provide newly enrolled members a "first fill" of any Part D approved medication that is not on that PDP's formulary, yet many pharmacists and patients don't know this. Clinic staff are having to do a lot of detective work to figure out what PDP a patient was enrolled in-many of them do not know-and then getting them switched to a plan that provides the drugs they need. A lot of this work is emergency triage to make sure there is continuity of drug coverage. In addition to working directly with patients and providing technical assistance and training to clinic workers, the two Initiative staff provide information to patients and family members who are competent to navigate the system with some direction.

The Board of Supervisors voted to allocate Measure A funds to help the community clinics and the medical center cover drug costs created by this so-called new drug benefit.
While this is an appropriate use of Measure A funds, it is hardly what we expected to be taxing ourselves for back in March 2004! Only the Bush administration could create a drug "benefit" that actually decreases coverage for many patients.

Governor Schwarzenegger extended emergency drug coverage for 15 days to seniors and people with disabilities on Medicare. More than one million "dual-eligible" Californians were switched from Medi-Cal to Part D, which provides more costly, less comprehensive coverage.

The federal Centers for Medicare and Medicaid Services (CMS) reports a 20% error rate in the Part D transition, meaning that perhaps more than 200,000 low-income Medicare recipients are at risk of not getting the drugs they need.

Put That Check in the Mail!

Vote Health members recently received a fundraising appeal from our state organization, Health Care for All - California. If you haven't already sent them a check, please do so now! We need the funds to build a powerful statewide grassroots campaign to support SB 840!

Send tax-deductible donations to
HCA-CA Education Fund
601 Hetts Lane
Sebastapol, CA 95472.

Newsletter committee:
Jan Arnold, Bradley Cleveland, Kay Eisenhower and Jim Forsyth.
Our thanks to CA Nurses Association for their help in producing this newsletter.