Your government on drugs
STARTING TUESDAY, RETIREES can sign up for the new Medicare prescription drug benefit. Besides some luck and patience, they’ll need an actuarial advisor, a personal pharmacist, a high-speed computer connection and maybe a sharp 12-year-old to help them navigate the Medicare website.
Oh, and one more thing: They could also use a government with the sense to change the program if it doesn’t work. It has the potential to be catastrophic for the U.S. Treasury, if not for retirees’ health.
Several foundations and advocacy groups, such as the Center for Healthcare Rights, are equipped to offer good advice to individuals. But they usually have small local staffs, which may be overwhelmed. (In Los Angeles County alone, for example, about 70 different plans are available.) There is a Medicare hotline, 1-800-MEDICARE, but it starts with a voicemail maze and is staffed by low-paid employees unlikely to have answers to complicated queries.
Recipients who are already in Medicare HMOs and satisfied with their offerings can accept their HMO’s default offering. Patients in nursing homes have protections to ensure that necessary medications won’t be interrupted. Those who are on Medi-Cal and Medicare are also automatically enrolled in a plan, and retirees with a drug plan through a former employer may want to keep it instead -- if the employer continues to offer it. And people with annual incomes of about $13,000 or less are being offered a simpler, more generous program.
That leaves the tens of millions in regular Medicare -- people who choose their own doctors.
The Medicare website, if it works properly, may be useful -- although the site is confusing, and 75% of Medicare beneficiaries, according to the most comprehensive survey, don’t use the Internet. For those who manage to enter their personal and prescription information, the site promises to show what purports to be the lowest-priced plan for them, but many details are omitted. Do certain drugs, and drug changes, require special authorization? For patients with severe chronic conditions, it could be crucial information. And each plan may change what drugs it offers from year to year.
True, these plans will reduce costs for most Medicare beneficiaries who don’t already have a good drug benefit. It’s just that the difficulty of making a “right” choice is mind-boggling. Meanwhile, fraud alerts are sounding because federal Medicare rules allow the plans to be sold by telemarketers. Bogus outfits intent on gathering seniors’ financial information may pose as “experts” promising to help them navigate the confusion of new benefits.
And then there are the taxpayers. Congress forbade Medicare from bargaining for lower bulk prices with drug makers and demanded that the benefit be sold through private insurers. The latest estimates of the cost to Medicare, which is already financially teetering, are from about $725 billion to $850 billion over 10 years, double what the benefit’s supporters had assured Congress it would cost.
Consumer and news organizations will be analyzing the various plans and should be unafraid to point out the winners and losers. If the benefit proves too daunting for a large number of the people it is intended to help, Congress should not hesitate to fix it, including a reconsideration of the ban on letting Medicare bargain for better prices.
People knowledgeable about the benefit hesitate to offer broad consumer advice. But retirees who are fairly healthy and without big drug costs at least have the luxury of time. The deadline to make an initial choice is May 15, 2006. By then, there will be a base of experience to learn from. By the second year, the good and bad choices should be more visible.
In the meantime, Congress should monitor the program closely and be willing to adjust it as necessary. Retirees who are able should polish their computer skills, make friends with a DSL line and pay their grandkids to analyze the offerings.
