theabcsofmedicare

Far Left Wing Medicare Rights Group Gets Medicare Facts All Wrong

Recently I wrote about the AARP getting its lefty noise out of joint because some multi-millionaire AARP members were going to have to pay a little more in Part B premiums. A similar odd refrain was found on Huffington Post from the far-left-wing Medicare Rights Center, which seems surprised that taxes will get raised on the middle class in the Democratic-Party’s solution to reducing the United States debt. 

How can that be, the lefty whines?  President Obama promised he would just tax “the rich.”

In addition, it’s scary that an article by someone claiming to be the head of the Medicare Rights Center made so many errors about Medicare reform proposals in this single article.

Poor $170,000-Plus-A-Year Seniors Face Higher Medicare Part B Premiums

It is really funny to see lefties in the AARP and the Associated Press (AP) getting all in a twitter because a couple that makes more than $170,000 a year in retirement has to pay $1000 more (about a half a percent of their income or less) for their Medicare Part B premium. And the retired bank examiner quoted by AP in the linked article probably belonged to a government union that backed the Democrats.

Of course the couple could always drop Part B and Medigap, put the $7000-$8000 they save (depending on cost of Medigap in PA) each year in a savings account, draw down from it as need be to pay co-pays in cash (which doctors love and give a discount for) and probably end up way ahead of the game. In fact, many of the rich people affected by this new Obamacare law are already doing that.

Medicare First Principles: Medicare Part B Supplementary Medical Insurance Is Not Medigap

(NOTE: This is part of a continuing series of "Medicare First Principles" posts that began here and continued here and here. Future posts will look at Parts B, C, D and Medigap and how the costs shake out for all of the above, including out-of-pocket costs for the many health care services most of Medicare does not cover or cover in depth.)

Medicare Part B is typically considered the doctor's piece of the Medicare action but that thinking is much too simplistic. Medicare Part B is "supplementary medical" insurance¹ that does cover some very specific types of doctor visits and surgeries but that also covers a hospital's charges for certain outpatient procedures and even a hospital's charges when simply observing a patient that is not admitted (this distinction between observed and admitted has important financial implications covered under the description of Part A linked to above). 

Medicare Part B is also the part of Medicare that -- under conventional wisdom -- you pay for ($105 a month in 2013 for most beneficiaries). Of course, seniors pay for all of Medicare through direct and indirect payroll taxes deducted during his or her whole working life. That's the way seniors really need to look at Medicare. 

Lefty Henry Aaron Proposes Folding "Private" Medigap into "Public" Medicare

Henry Aaron, the lefty revolving-door think tanker who the left-wing press claims first¹ brought us the "premium support" idea, is out recently with what looks like a new idea to me. (But -- with Medicare reform -- there are really no new ideas.) Aaron suggests folding Medigap -- particularly first-dollar-coverage Medigap -- into Original Medicare as an option offered by the Medicare bureaucracy rather than it being a separate insurance service from dreaded "private insurers." 

The benefit -- with which I agree -- would be to eliminate a layer of complexity (see chart above from "Medicare and You") in beneficiaries' Medicare decision tree. Or at least it would move the box on the lower left up into the heart of the flow chart and position Medigap and Medicare Advantage equally on the flow chart as the real options they have always been:

• Uncoordinated fee-for-service network-free health care for which you usually pay more for the network-free choice of providers (Medigap)
• Vs.
• Coordinated capitated networked health care for which you usually pay less for provider-network restrictions (Part C Medicare Advantage)

I like it because it would end the useless and intelletually dishonest private vs. public debate about Medicare typically used by lefty academics and think tankers like Aaron to attack those of us who freely choose the "public" coordinated networked health care of Medicare Part C. If Aaron's suggestion were adopted, all Parts of Medicare purchased individually would then be "public." (And all Parts would presumably still be administered by private insurance companies as they are now, which is why the current debate is intellectually dishonest.).

I guess a plurality of seniors could still get their supplemental Medicare insurance through groups the way they currently do but Aaron does not appear to address that issue in his 10,000-word dirge. That length is the bad news. Aaron's good idea is buried at about the 7,000-word point in his 10,000-word snooze about all the things wrong about Republicans and non-enrolled voters (and the few remaining neanderthal Democrats, I guess). 

One of the oddities of this article is Aaron's multiple reference to Medicare Supplementary Insurance (SMI). What he's talking about is Medicare Part B; almost no one uses the SMI term because it gets confused with Medigap. I can only assume that Aaron is trying to confuse readers on purpose but I can't figure out why (unless he doesn't want to tell the nurses and firefighters on good government retiree plans that he wants them to pay a lot more for their Medicare Part B than the rest of us non-governmental retirees?).

¹ To the best of my knowledge, or at least for the 45 years off and on that I bought employer-sponsored healthcare insurance, there has always been premium support.  Aaron might be able to lay claim to first suggesting it for Medicae however; I don't know. Not surprisingly, througout his 10,000-word article, Aaron calls the concept "premium support" when he talks about Democratic-party ideas or positions and calls exactly the same concept "a voucher system" when knocking a Republican-party position or idea. It is hard to keep changing hats like that.

Medicare First Principles: With Medicare Part A, the Key Word is "Admitted"

(NOTE: This is part of a continuing series of "Medicare First Principles" posts that began here and continued here. Future posts will look at Parts B, C, D and Medigap and how the costs shake out for all of the above, including out-of-pocket costs for the many health care services most of Medicare does not cover or cover in depth.)

Medicare Part A is hospitalization insurance for a set amount of days during which the beneficiary is actually "admitted" to an acute-care hosptial. Part A also covers a set amount of time in a skilled nursing facility, typically for "occupational" or physical rehabilitation (and never for nursing care related simply to old age), as well as for hospice and limited home health care services under certain conditions.

The word "admitted" is key, as explained in the above fine print from the "Medicare and You: 2013" booklet, because it is possible to stay overnight at a hospital -- even for multiple nights -- and not be "admitted." Medicare beneficiaries who are not actually "admitted" to a hospital face financial consequences two ways: 

• The "observed-status" hospital bill is paid by Medicare Part B (see a future post) instead of Part A, usually at a higher co-pay¹
• If un-admitted hospitalization (typically the word "observed" is used) leads to a recommendation for transfer to a skilled nursing facility (SNF), neither Medicare Part A nor Part B will pay for the SNF (no current Part of Medicare covers long-term care such as nursing homes or assisted living)

As complicated as that sounds, the admitted/observed conflict is not the biggest drawback of Medicare Part A. The really bad news is that Medicare Part A coverage has fixed per-incident deductibles on the low side and lifetime limits on the high side.  It is the worst possible insurance design imaginable (equalled only by Part B, to be discussed on a future post), protecting seniors

• Neither against high costs under the best actual hospitalization scenario assuming you have to be hospitalized (e.g., a one-night stay where no problem is found or a simple procedure is performed costs almost $1200 in 2013 whereas under most non-Medicare insurance plans the cost would be between $100 and $500)
• Nor against total financial catastrophe (see this example of a Medicare beneficiary in Miami that needed a heart pump)

Part A insurance costs about $400 a month in 2013 but it is typically "free," based on years of dedicated payroll taxes.

¹ The term co-pay is used throughout the following related Medicare-First-Principles blog posts, although technically the out of pocket cost to the beneficiary might be a deductible or co-insurance rather than a co-pay according to insurance plan terminology.

GAO Shoots Down Left-Wing Economists' Absurd Arguments about Medicare's Efficiency

For people actually on Medicare, the absurd ad-nauseum left-wing assertions that Medicare is efficient gets tiring. But it's Winter-Summer Solstice/Christmas/Hanukkah/Kwanza/New Year's/Etc. and there's not much else to read or talk about. So here's a December 2012 Government Accountability Office (GAO) report on just how totally and utterly inefficient Medicare is. (There is a companion GAO report on Medicaid; the story is just as disturbing.) Imagine any non-government enterprise that could continue running year after year wasting almost $30 billion or more.

The intellectually dishonest analysis by left-wing economists and goo goos usually claims Medicare's administrative costs are low without mentioning that most of its costs are included in other government budgets (such as in Social Security's and the IRS' budgets).

The lefties also consistently and dishonestly trot out the public vs. private canard:  Original Democratic-party Medicare Parts A and B are just as much or just as little private insurance as Modern Republican-party Medicare Parts C and D. For all Parts of Medicare (A, B, C and D), the government (public) is the payer and insurance companies (private) are the administrators. Note the reference to "Medicare Adminstrative Contractors" or MACs in the GAO report above. Guess what, you intellectually corrupt and deceitful lefties: they are all private for-profit insurance companies.

But that is all just a sidelight to the main show about Medicare reform.  The real discussion should involve looking at Medicare in the complete context of the entire healthcare insurance and delivery market... cradle to grave. 

• The way Medicare price fixing by Congress drives up the costs of other healthcare (and therefore other healthcare insurance)
• The way current and proposed rules about Medigap first-dollar coverage and Medigap plan design affect senior choices such that the costs of other healthcare (and healthcare insurance) rises even more
• The way Medicare services restrictions drive up out of pocket spending by seniors and other Medicare beneficiaries and thereby drive up other healthcare costs (and health insurance costs)

When you do that, you rapidly reach the conclusion that Original Democratic-party Medicare is the worst insurance ever designed: combining no catastrophic coverage on the high end with high co-pays and deductibles on the low end. 

This poor design -- as explained here -- is the result of Original Medicare's historic resemblance to 1960's Blue-Cross/Blue-Shield Major Medical insurance.  Original Medicare is stuck in the 1960s, just like the Democratic party's academics and goo goos.

More Obamacare Bait-and-Switch In "Free" Medicare Preventive Screenings for Seniors

Here’s another one of those little things that screams “Medicare has to be reformed.” It's more of the crazy explanation of -- or actual implementation of -- so-called "free" preventive screenings for Medicare beneficiaries.

I think it will affect everyone on Medicare NOW and everyone signing up for Medicare IN THE FUTURE… IF I am reading the “Medicare and You” booklet correctly¹.

One of the great “new” free preventive screenings the Medicare bureaucracy touts is the Abdominal Aortic Aneurysm Screening via ultrasound. But in “Medicare and You” (top of page 33 in 2013 version), the Medicare bureaucracy claims that the free screening MUST be prescribed as part of a “Welcome to Medicare” preventive visit (WMV).

So that leaves the questions:

• What about those over 66 who had their WMV years ago but now need the aortic-aneurysm test?
• Or what about those that never had a WMV? 

Medicare and You very specifically says the screening has to be prescribed at a WMV. I guess that means that the “free” screening cannot be prescribed at a later Annual Wellness Visit (AWV)².

And the Medicare and You booklet also strongly implies that the aortic-aneurysm test is not otherwise covered by Medicare at all. I guess seniors that need such a test later will need to pay out of pocket entirely for the test.

Moral of story (if my interpretation is right): Everyone just signing up for Medicare Part B should have a Welcome to Medicare visit – despite the fact that everyone says it is a waste of time. You have to have it within the first 12 months of being on Part B. And you should ask for the free aortic aneurysm screening if nothing else.

(This advice assumes this is a useful test. It has been discovered by health-care researchers that other “free” Medicare screening tests such as the PSA test for prostate cancer are not very useful.)

¹ I have asked AARP’s Ms. Medicare, Patricia Barry, to see what the Medicare bureaucracy says about this issue. I will update if I hear any more.
² Unlike annual wellness visits, WMVs are not new with Obamacare; it has always been the case that you had to have had your WMV during the 12 months after you signed up for Part B, or you lost the right to have one. Not many people have bothered to get a WMV -- pre or post Obamacare -- because neither a WMV or an AWV is actually a physical as explained here by the AARP’s Ms. Medicare

Medicare First Principles: What Medicare Does and Doesn't Cover

Eventually Medicare has to be reformed.  To help seniors and soon-to-be seniors better understand why -- and what might and might not work in terms of Medicare reform -- this is the second in a series of blog posts that go back to Medicare "first principles." In other words, forget anything you've heard about the Medicare program and simply take it from the ground up with no pre-conceived impressions. The first post in this series is here.

The best source for what Medicare covers is a Medicare-bureaucracy document called "Medicare and You." It is issued around October 1 of each year to cover at a high level all the aspects of the Medicare program for the following year (so, the current version is called "Medicare and You: 2013")

There are four Parts to Medicare -- A, B, C and D:

• Parts A and B are commonly called Original Medicare although you will also hear the terms traditional Medicare or "Medicare as we know it;" saying "Medicare as we know it" is quite meaningless since Medicare has changed almost every year since first created almost 50 years ago
• A is "admitted" hospitalization insurance for a set amount of days that also covers a set amount of time in a skilled nursing facility for rehabilitation.
  • NOTE: Part A does not cover nursing homes; no current Part of Medicare covers long-term care such as nursing homes or assisted living.

 

• B is "supplementary medical" insurance that primarily covers some very specific types of doctor visits but that also covers a hospital's charges for certain outpatient procedures and even a hospital's charges when simply observing a patient that is not admitted (this distinction between observed and admitted has important financial implications to be covered in another post). 
  • NOTE: Do not confuse the term "Part B supplementary medical insurance" with private "supplemental Medicare insurance," commonly called Medigap insurance.
  • NOTE: Under the Patient Protection and Affordable Care Act (PPACA) of 2010 -- better known as Obamacare -- a list of various preventive tests have been added to the types of doctor visits covered by Medicare; some of these preventive tests are even provided "free." However, the most important preventive test -- an annual physical -- has never been covered by Original Medicare and is still not covered even after PPACA
  • NOTE: Among other types of doctor visits not covered, Medicare does not cover vision or hearing exams, routine dentisty, cosmetic surgery or acupuncture
  • NOTE: Part B does cover some medical equipment and transportation by ambulance -- but not by wheelchair transit companies -- in circumstance too numerous to describe in detail because of the complexity of what is covered and not covered and when
• Part C Medicare Advantage combines the benefits of Original Medicare Parts A and B at a minimum, but adds catastrophic coverage at a minimum and typically adds coverage of the many services -- such as vision and hearing services, drug coverage, annual physicals, and much more -- not included in Original Medicare
  • NOTE: Original Medicare -- like the 1960s-era Blue-Cross/Blue-Shield Major Medical insurance on which it was modeled -- does not include catastrophic coverage; this is probably the major limitation of Original Medicare
  • NOTE: It is a common misconception that Part C Medicare Advantage subscribers "give up their Medicare rights" if they choose Part C; this is not correct and the government bureaucracy in charge of Medicare has tried to change this misconception by re-wording many parts of the "Medicare and You" booklet for 2013. In fact, not only is Part C a full "Part" of Medicare but subscribers cannot subscribe to Part C unless they are first subscribed to Original Medicare Parts A and B and subscribers to Part C have to keep paying their Part B premium. 
• Part D Standalone Prescription Drug Plans are just what they say they are; insurance to pay for prescription drugs.  Each plan -- although approved and regulated by the Medicare bureaucracy -- is independent and covers whatever drugs it wants at whatever prices it can negotiate with manufacturers and distributors.
  • NOTE: Under the 2003 law that created Medicare Part D Standalone Prescription Drug plans, the plans have a unique deductible concept, called formally the coverage cap and informally "the donut hole," that affects a small number of middle and upper income subscribers in the middle of their prescription drug spending (as opposed to at the beginning or the end of such spending, the way most insurance plans of all types -- fire, auto, disability, etc. -- work). Initially this small group of subscribers had to pay for all their drugs in the donut hole.  Under PPACA, the amount they have to spend in the hole for any prescription is being gradually reduced through 2020 to the same co-pays as during the initial spend phase of coverage. As a result, the Medicare actuary predicts that the cost for all Part D insurance plans will rise. Also, because the plans are independent, plans can choose not to cover certain drugs.

 Over time, I will blog in detail on each of the Parts of Medicare as well as on the financial implications such as co-pays, deductibles, co-insurance and out of pocket expenses.

Medicare First Principles: What Is Medicare?

Eventually Medicare has to be reformed.  It is a bad insurance program, badly conceived by the Congress in its many iterations and badly implemented and managed by the government bureaucracy in charge of it. 

To better understand why -- and what might and might not work in terms for Medicare reform -- I am writing a series of blog posts that go back to Medicare "first principles." In other words, forget anything you've heard about the program and simply take it from the ground up with no pre-conceived impressions. The following is a First Principles starting point, a series of unbiased totally factual and indisputable statements that might make it easier for you to understand what is really happening -- and why -- when it comes to Medicare reform.

• There are four Parts to Medicare -- A, B, C and D; all are equally public and private in that
  • The government is the primary payer of all Parts -- A, B, C and D -- just as, for most people prior to going on Medicare, an employer is/was the primary payer
  • All Parts of Medicare -- A, B, C and D -- are administered by private insurance companies, just as, for most people prior to going on Medicare, the employer who is/was their primary payer hired an insurance company to administer its employee's health care claims

 

• Original Medicare Parts A and B were created in 1965 and are "Major Medical" health care insurance, a 1960s-era insurance concept typically associated with Blue Cross and Blue Shield as those two concepts existed in the 1960s
• Original Medicare is paid for by all Medicare beneficiaries three ways:
  • Years of dedicated payroll taxes, which fund Part A,  "Blue-Cross-like" hospitalization insurance
  • Years of general income taxes, which fund an estimated 75% of the "Blue-Shield-like" Part B "supplementary medical" insurance (do not confuse the term "supplementary medical insurance" with private "supplemental Medicare insurance")
  • A monthly premium paid by most beneficiaries (once on Medicare), which funds an estiamted 25% of Part B services
• Original Medicare covers a narrow, restricted set of healthcare services
• Today, less than 10% of Medicare beneficiaries depend only on Original Medicare to cover the costs of their healthcare services; that trend goes back to the creation of Original Medicare in the 1960s (although the percentage has varied)
• Additional public Medicare options include Part C Medicare health plans and Part D standalone drug plans
  • Part C Medicare Advantage, based on Medicare demonstration projects that date to the 1980s, formalized in a law first passed in 1997 and revised in 2003 and 2010, combines the benefits of Original Medicare Parts A and B at a minimum, adds catastrophic coverage at a minimum (Original Medicare -- like the 1960s-era Blue-Cross/Blue-Shield Major Medical insurance on which it was modeled -- does not include catastrophic coverage), and often includes other benefits not included in Original Medicare
  • Part D Standalone Prescription Drug Plans, based on a law passed in 2003, implemented in 2006, and revised in 2010, provides Medicare beneficiaries who -- at a minimum -- are signed up for Part A various levels of prescription drug coverage (Original Medicare does not include prescription drug coverage except for certain specialized drugs administered in outpatient environments)

Over time, I will blog in detail on each of these statements.

Obama Considering Raising the Monthly Medicare Part B Premium Almost 50%

The "Myth of the $247 Medicare Part B Monthly Premium" may not be such a myth after all. For a couple of years now, there has been a chain email going around among seniors claiming that Medicare Part B premiums would more than double -- to $247 a month -- in 2014 because of the Patient Protection and Affordable Care Act, better known as Obamacare.  Everyone knowledgeable about how Medicare works -- including me -- has shot down the chain letter's arithmetic and logic.

But like all myths there is a kernel of truth under the numbers. In fact there are three kernels of truth under the numbers in this myth.

• First, Obamacare does affect the Medicare Part B premium for many seniors.  This AARP article fully explains what's really happening on that front.  Among other things, high-income seniors have long paid more per month than most of us seniors, even more than $247 a month, in Medicare Part B premiums. What Obamacare does is redefine which seniors the government considers "high income." It used to be only 5% of us seniors.  Under Obamacare, now 15% of us are considered high income. Three times as many seniors will pay the higher premiums, and beging to approach the mythical $247  a month. Ker Ching!
• Second, the Social Security "hold harmless" rule has affected the Medicare Part B premium in three of the last five years, most dramatically in 2010 and 2011 but also to some extent in 2013. Under the hold harmless rule, the premium of a senior already on Medicare cannot go up more than his or her Social Security income. So many seniors think of Medicare Part B as having cost around $95 a month in 2009, 2010 and 2011 with a raise to $100 in 2012 and 2013. That sounds pretty reasonable.  But that's not the real Medicare Part B premium, that's just what many seniors paid if they were "held harmless." The real monthly Part B Medicare premiums in those years were $95, $105, $116, $100 and $105 respectively. In other words the real Medicare Part premium can move all over the map depending on Social Security inflation factors. And guess what? President Obama and the Democrats plan on changing the Social Security inflation factor. I have no idea what that change would do to Medicare premiums but probably not something good. Ker Ching!
• Third, the Obama administration is reportedly thinking about changing the formula by which the Medicare Part B premium is calculated. The most often proposed change would increase the monthly Medicare Part B premium by almost 50%. You will notice in the AARP article and in every other denial of the $247 myth that the major argument against the myth -- correctly -- is that no one can know what the Part B premium will be in subsequent years because the premium is 25% of the projected total government spending on Part B services. And no one knows what that projected total is until the year in which the rate is set. But no one ever explains that Congress can very easily change that 25% and a popular current proposal is to change it to 35% of projected spending, an almost 50% jump. Ker Ching!

So Ker Ching, Ker Ching, Ker Ching. A senior retroactively declared "high income" by Obamacare, feeling the effect of a crazy Obama-administration inflation environment, and hoisted on the petard of a new Part B formula could easily see $247-a-month Medicare Part B premiums.  It might be 2016 instead of 2014 but it looks a lot more likely than AARP and others would have us seniors believe.

Harvard Professors Keep Proving RyanCare Better than Original Medicare

It must be driving these Havard professors nutty every time they prove that the Part-C-Medicare-Advantage-like RyanCare approach to simplifying the Medicare mess is the way to go. That's just not what such lefties from Harvard are supposed to say.

The Democratic party line is that Part C Medicare Advantage is a program in which the Republican-created Medicare Part C program lets blood-sucking greedy insurance companies dupe stupid senior citizens into accepting inferior health care while robbing taxpayers blind. But apparently the data indicates somethign different. According to Healthcare Finance on December 4th according to December's Health Affairs (in a gated article),

"... researchers, led by Harvard Medical School professor Bruce Landon, used effectiveness and utilization data submitted to the Centers for Medicare & Medicaid Services (CMS) by Part C Medicare Advantage health plans, as well as CMS’ consumer satisfaction surveys. The sample sizes grew from 3.1 million Part C Medicare Advantage HMO enrollees in 2003 to 5.7 million in 2009 and included data from 280 health plans by 2009. The authors studied rates of medical and surgical hospitalizations, outpatient visits, ambulatory procedures, emergency department visits and twelve specific surgical procedures, and compared Part C Medicare Advantage HMO plans to CMS enrollment and claims data from a random sample of traditional Medicare beneficiaries, adjusted for demographic factors. They found Part C Medicare Advantage HMO enrollees had 25 to 35 percent fewer emergency department visits, compared to traditional Medicare enrollees, and had 20 to 25 percent fewer inpatient medical days. Part C Medicare Advantage HMO plans also had fewer ambulatory surgeries and procedures than in traditional Medicare, with ambulatory utilization 25 percent lower in 2003, before narrowing to 7 percent by 2008. "

Back in August 2012, a bunch of left-wing Harvard guys -- including one of the many self-proclaimed architects of Obamacare -- used 2009 Part C Medicare Advantage data to prove that under the competitive bidding system proposed for RyanCare private insurance companies could deliver the same benefits as Original Medicare at up to 15% less cost to both seniors and the government than the insurance companies that administer Original Medicare. They are are often the same insurance companies of course so it is the rules of Orignal Parts A and B Medicare versus the rules of Part C Medicare Advantage and proposed for RyanCare that must be causing this result.

As part of the August 2012 Harvard research paper, the self-proclaimed Obamacare architect -- David Cutler -- mustering all the intellectual rigor you expect from Harvard stated he was sure the Part C Medicare Advantage insurers were gaming the system somehow to cause those results but he couldn't figure out how they were doing it.  Well, bad news, professor. Some other Harvard professors just proved that that is not the case. (Somehow this third group of Harvard professors turned that finding into good news for Obamacare! But that's beside the point.) 

Meanwhile, seniors, sorry but you're screwed.  Isn't interesting that most of the information about how the Republican's RyanCare proposal would work better than the Democratic Party's Original Medicare seems to be coming out after the election? And Medicare Part C Medicare Advantage is still going the way of the Princess phone thanks to Obamacare.

Seniors Save $100 Billion This Year with Medicare Part D

Medicare Part D drug coverage is a program bitterly opposed by the Obama administration and slated to be gutted by the Democrats in 2013. So how come with annoying and expensive regularity the Obama administration propaganda machine puts out a press release that says United States seniors have saved $xx billion because of Obamacare closing¹ the so-called Medicare Part D drug program donut hole. 

This propaganda refers to the discounts that about 5% of Medicare beneficiaries receive if they and their insurers spend more than about $3000 on their drugs in a given year (as measured by retail value). The discounts were a concession drug manufacturers made to the Obama administration in 2009 in a side deal to avoid the Feds socializing the Medicare and Obamacare drug programs totally (back when the Democrats controlled both the Congress and the administration). It was actually a great deal for the drug manufacturers because they knew most of the drugs covered were going generic anyways (and therefore their profits would dissipate anyways). In return, the drug manufacturers are going to pick up 30,000,000 new customers via Obamacare.

And how come I never see a press release from the Republicans about the fact that 50% of United States seniors have saved a $100 billion this year because of the Medicare Part D program itself, the Part D coverage that 95% of us seniors use.

¹ Obamacare did not actually close the donut hole but that's another story you'll hear all about after President Obama guts Medicare Part D this year.