Rethinking health care

There's bad news in store for feds. Health benefit premiums are going way up next year. Although the Office of Personnel Management says the average premium will increase by 13 percent, premiums for the Blue Cross and Blue Shield Service Benefit Plan, which covers more than half of all feds, will go up by 20 percent for individuals and 17 percent for family enrollments.

OPM officials correctly point out that health benefit premiums in the private sector are going up by even greater amounts, but there's not much comfort in that. What I care about is how much pay is left after deducting taxes and health benefit premiums.

OPM officials have tried to control health benefit costs, but it doesn't look like they're succeeding. For example, Blue Cross/Blue Shield and the Government Employees Hospital Association Inc. are both dramatically increasing the copayments they charge for mail-order brand-name prescription drugs. Currently, you can get a 90-day supply of a generic drug for $12 and a brand-name drug for $20. Next year, you'll pay $10 for a generic drug and $35 for a brand-name drug.

For starters, I'd like to know why both plans suddenly raised their prescription drug charges by the same amount? It smacks of collusion. The other fee-for-service plans have also raised their prescription drug charges by approximately the same amount, after keeping them constant for a number of years.

My guess is that Blue Cross told the other plans what they were going to do, and they followed suit. OPM shouldn't have let that happen. What each plan proposes to do should be kept secret. If all the car companies got together and decided to raise prices by the same amount, the government would intervene and disallow the increases under existing fair trade and anti-monopoly legislation. I think such legislation should be invoked in this case, but that's not likely to happen.

The copayment reduction for generic drugs — from $12 to $10 — also is annoying. The plans seem to be encouraging feds to ask their physicians to prescribe generic drugs, but many drugs aren't available as generics. The pharmaceutical companies keep coming out with better drugs, and they have patents that prevent generic-drug companies from competing, forcing patients who want generic drugs to settle for the next best drug available, not the best. In practice, health plans are really asking you to forgo the best treatment for your disorder in exchange for a lower price. That's unconscionable.

Under existing law, the percentage of health benefit premiums the government pays is fixed by a formula, but the amount employees pay isn't, which means that current legislation puts a cap on government costs but not on employee costs. Whoever drafted the Federal Employees Health Benefits legislation wasn't thinking. Congress should go back and revise this program, and feds should contact their representatives in Congress — unless they're hiding — and insist that this be done.

Zall is a retired federal employee who since 1987 has written the Bureaucratus column for Federal Computer Week. He can be reached at [email protected]


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