Drug plan needs dose of simplicity
Opinion
Atlanta Journal Constitution
January 27, 2006
The fiasco during the first few weeks of Medicare’s prescription drug program seems to provide critics of government-provided health insurance with a wealth of ammunition.
But before firing off the first round, those critics should look closely at what has happened. Yes, the program has been a disaster. But it has been a disaster mainly because government turned its citizens into captive customers for private firms looking to maximize their own profits, then provided those citizens little protection.
The biggest immediate problem was an example of the fundamental flaw with the plan. An estimated 6.2 million beneficiaries (including about 135,000 in Georgia) had drug coverage through state Medicaid programs and under law had to be moved into one of the new federally funded but privately operated Medicare plans.
Some of these poor and elderly patients never got assigned to a private drug plan; others did get switched, but information about their enrollment didn’t get transferred from government computer databases to those maintained by the private companies.
On Dec. 31, those people were doing fine with the government drug plan they had, but after Jan. 1 — the date the new Medicare plan went into effect — many were told their newly assigned plan did not cover the drugs they routinely take to stay alive.
Computer records were often missing and pharmacies had to extend their customers credit. In about half the states, government officials had to step in and guarantee coverage until the glitches were fixed.
While some of those technical difficulties are being ironed out, other problems won’t be solved so easily. For example, consumers are still being forced to choose from dozens of plans offered by private companies, each with its own schedule of co-payments, monthly premiums and lists of which drug it will cover. Trying to make financial sense of all those options would challenge even a professional accountant, yet senior citizens are being forced to make that decision with little or no assistance.
Contrast that with how traditional Medicare pays for hospital care: The hospital is paid a flat rate based on the patient’s diagnosis, severity of illness and length of stay. The patient is not forced to choose among competing plans for hospital care, and rarely sees a bill. Medicare tells the hospital what it will pay. (Physician services come under another relatively simple Medicare plan with fixed premiums and standard benefits).
So far, Medicare has enrolled about 24 million beneficiaries in the new plan, but many of those already had some form of drug coverage. Unfortunately, the worst sign-up rate is among the 12 million to 15 million beneficiaries who had little or no drug coverage to start with. Only about 3.6 million of these low-income Medicare beneficiaries have signed up for one of the drug plans.
At some point the nation’s senior citizens and others covered by Medicare will demand to know why the drug program is so complicated and works so poorly compared to the simplicity and cost-effectiveness of how Medicare handles hospital and physician coverage, and how it can be changed.
The answer will be a national health insurance program utilizing the government’s purchasing power to provide the highest quality of care at the most reasonable cost, for patients and taxpayers alike.