Medicare Part D is, indeed, a scam. I wasn’t sure until I cross-posted my piece from here on the Huffington Post and read the seventeen comments it got. One of the most interesting was from a pharmacist, who compared what he knew the costs of the prescriptions his dad paid were to what his Part D plan charged him, and found that the Pharmacy Benefits Manager for his plan charged a higher co-pay than necessary just to get him to the donut hole faster. Another was from a woman who priced drugs with and without insurance and found the cost of her drugs to be $200 a year cheaper without insurance.

This is yet another thing health care consumers don’t totally understand: when you add a layer of management, you add a layer of profit. Managers don’t manage for nothing. Now that we have our drugs “covered” by insurance (public or private), someone has to be paid to manage the benefits.  That entity is a Pharmacy Benefits Manager. The cost of that Pharmacy Benefits Manager (PBM) is added on to the cost of your prescriptions, as are other costs associated with marketing and selling drugs to the Pharmacy Benefits Manager (which is called “getting the drugs added to the formulary”). The “formulary” is the list of drugs your plan will pay for. Like everything else, Medicare Part D has a formulary, and the different Part D plans have PBMs.

To the consumer, sick or well, this is all so much mumbo-jumbo. What you have to know, whether you are on Medicare or on a private plan, is that all this “management” costs money, and that for the past few years, the drug companies have been claiming their expenses are research and development.  Some are, but others are marketing, and still others are management.

And this is why health care needs to be single payer: in any other industry, if the prices of a product got to be higher than you could afford, you would tell the company to take a hike, substitute a cheaper product, do without the product, or make it yourself to save money. You cannot do this with health care (although more consumers are trying). But you can’t do that with health care, can you. And that’s why after all the noise against Obamacare, socialized medicine, and everything else nasty, the debate is coming back around. We have to do something to reign in costs. Period.

Senator Merkin from Oregon wrote a piece in the Huffington Post yesterday that deserves your attention. You have to be concerned enough to remember when Frank Luntz, noted Republican pollster, drove all honest people crazy by turning English into Doublespeak and twisting words so they didn’t mean what we thought they did. Sen. Merkin says he’s back:

” I was shocked when I read a memo from Republican strategist Dr. Frank Luntz laying out plans to dismantle any effort to give all Americans access to quality health care. Dr. Luntz, the man who developed language designed to promote preemptive war in Iraq and distract from the severity of global warming, is at it again — this time with a messaging strategy designed to sink our historic opportunity for health care reform.”

According to Merkin, Luntz is out to kill health care reform even though he knows Republicans won’t get what they want, either. This is the original zero sum game.

“Dr. Luntz lays out multiple ways that opponents of health care reform can trick and manipulate the American public. One strategy that stood out to me is to call efforts to reform our broken health care system a “bailout for the insurance industry.” This statement is developed to serve the same interests who stopped at nothing to derail health care reform in the 90′s, who blocked health care coverage for low-income children, and whose top Medicare priority for 15 years has been transferring money from seniors and taxpayers to the insurance industry.”

Even the insurance industry is now engaged in constructive negotiations about how to repair the health care system…however, Dr. Luntz’s new game plan to stop change is being embraced by leaders in the Republican Party. In a briefing where Dr. Luntz presented his strategy to Republican House members, Rep. Mike Pence from Indiana, the chairman of the House Republican Conference, made it official by saying, “Frank is back.”

The bad thing about all this manipulation of languages is that when voters get confused and can’t really follow the issue, they vote no. It would be awful if the result of Luntz’s work was to get Americans to call their representatives to oppose the very thing the country needs most.