By Robert Hayes - 11/09/05 12:00 AM EST
The United States is appropriating hundreds of billions of dollars to meet a basic human need — affordable prescription medicine. This should be a moment of celebration.
For nearly 40 years, Medicare has been a national treasure. It is a program that has done what it promised: Life is better and longer thanks to Medicare. Illness in old age is no longer a straight line to the poor house, and the efficiency of this single-payer national health plan tops the most profitable private health plans.
The reason that millions of Americans are confused, angry and frustrated over the new drug benefit is that its designers ignored the lessons of what has made Medicare great. And the route to fixing it is to go back to what we know works.
President Lyndon Johnson signed legislation creating Medicare on July 30, 1965. Just 11 months later the program was up and running, and 93 percent of eligible men and women voluntarily enrolled in the new, untested program. Today, Medicare achieves the highest satisfaction rates of any health-coverage program by far.
Medicare allows doctors to decide what healthcare is necessary for a patient. Medicare allows patients to choose their physicians, therapists and hospitals. Virtually all healthcare providers accept Medicare. People with Medicare understand the services that are covered, and they can calculate ways to meet their out-of-pocket healthcare costs.
Reliable and affordable: these are the principles that have made Medicare a success story. And cost containment has been achieved with a largely winning formula of paying healthcare providers just enough to keep them in Medicare but not so much that commercial profiteering takes control.
These are the lessons lost on the designers of the new drug benefit, and a return to these values — reliability and affordability — should lead Congress in 2006 to enact a Medicare drug benefit.
Wait, isn’t that what we are launching Jan. 1?
To the contrary, this drug benefit has little to do with the Medicare program that has so enriched our nation. What Congress enacted is a cottage industry of for-profit drug plans competing for the business of people with Medicare.
When for-profit drug plans commit hundreds of millions of dollars to promotional and advertising campaigns to win enrollees to their tax-subsidized bill of goods, something is wrong. When one-time statesmen such as former Sens. Robert Dole (R-Kan.) and John Breaux (D-La.) become mercenary pitchmen for these plans, something is very wrong.
The for-profit drug plans force older and disabled Americans to make choices that no one in our nation should have to make — between a drug plan that covers their drugs but is not affordable and one that’s affordable but does not cover their drugs; between a drug plan that covers their drugs today but may not meet their needs tomorrow and a drug plan that does not meet their needs today but may meet their needs tomorrow.
Medicare is about providing health security, affordable coverage and reasonable choice. The new drug program is the opposite.
Jan. 1 will come, and the drug program for people with Medicare will have its messy launch. Some people — especially poor people without any drug coverage today — will receive substantial help if they can make their way through the application process.
Many more will receive inadequate help. The benefit is limited, and people will be forced into wrong choices by the complexity of the plans and by the misleading promotions blanketing the market.
Perhaps most will ignore the program. These are people in need of affordable medicine but unable to navigate the crazy quilt of plans with their dizzying array of co-pays, deductibles, coverage gaps and changing list of covered drugs.
This is the beginning, not the end. A more enlightened Congress will see the waste and hardship this program presents and should:
• Immediately ban telemarketing and the misleading barrage of advertising and promotional materials blanketing the world of older Americans.
• Allow people with Medicare to change plans as often as plans are allowed to change covered drugs.
• Suspend for a year any premium penalty for late enrollees.
• Extend the “Extra Help” subsidy automatically to all Americans who meet the program’s income limit.
But most of all, Congress should enact a Medicare drug benefit.
Like Medicare, the benefit should be nationwide, reliable, comprehensible and comprehensive. It should be a Medicare benefit, managed by Medicare to drive prices to a level that will enable people with Medicare, and the American taxpayer, to get a dollar’s worth of medicine for a dollar paid.
Hayes is president of the Medicare Rights Center.