Lost in the Medicare maze: a Phi Beta Kappa scholar tries to figure out Medicare Part D (Prescription Drug Improvement?)

Lost in the Medicare maze

By Gilbert Cranberg
USA Today
10/26/05

My wife has a master's degree and worked for 50 years as a health care professional. I have a master of arts, plus a Phi Beta Kappa key.

For more than a half-century, I delved into, and commented on, complex public policy issues. We have ready access to advice from our children: two physicians, a lawyer and an insurance man.

Nevertheless, my wife and I are baffled by the incomprehensible turn Medicare has taken with passage of the Prescription Drug Improvement and Modernization Act of 2003.

Acquaintances tell us they are equally at sea -- and drowning in sales pitches that began Oct. 1. Enrollees can begin signing up Nov. 15, though coverage won't start until January. In Iowa, where seniors are as ubiquitous as corn -- the state is No. 2 in elderly 85 and older and fifth in persons 65 and older --The Des Moines Register recently called for a moratorium on implementing the law, saying it is "massively expensive ... complex, confusing and could use a lot of fixing."

Our dose of reality

Hell hath no fury like seniors riled. And they will be furious once the full implications of what has been done to Medicare sink in.

My wife and I had a taste recently when we sought help from Iowa's Senior Health Insurance Information Program. The advice, from a retired insurance executive: The new prescription drug program is not a good deal, but we should sign up for it anyway because the 1% per person penalty per month for delay would force us -- if we changed our minds and enrolled after a year -- to pay 24% (12% per person) more each month for the rest of our lives. In other words, a program deemed not in our interests at the outset would get progressively worse.

As part of the law's design to privatize Medicare, enrollment in the prescription drug program can only be through private insurers that contract with the federal government. So seniors have to puzzle out multiple plans, each with its own charges, coverage and formulary to determine which, if any, is advantageous.

The prescription drug program is simplicity itself compared with what else awaits seniors. The big push to privatize lies in the Medicare Advantage component of the law, wherein the government lavishes tens of billions of dollars on private insurers to lure seniors from traditional Medicare to private coverage. In Medicare Advantage, seniors confront a maze of competing private plans and a whole new world of co-pays, deductibles and rules for physician choice.

My state insurance department adviser urged me to shun Medicare Advantage in favor of traditional Medicare. His advice accords with what The Register recently told its readers when it called the effort to lure seniors from traditional Medicare bad for beneficiaries, bad for taxpayers and bad for the country.

Beware of sticker shock

How bad hasn't even begun to sink in. Seniors will be hit, beginning Jan. 1, with a monthly Medicare premium increase of $10.30, to $88.50. The largest chunk of that increase, more than 13%, is accounted for by payments for Medicare Advantage. The Centers for Medicare and Medicaid Services predict that the prescription drug benefit will save seniors "many hundreds of dollars" and Medicare Advantage, "on average," will save beneficiaries about $100 a month. That agency, however, is an arm of the Bush administration's Department of Health and Human Services, which is marketing Medicare Advantage.

Traditional Medicare has been popular, even revered. A poll in 2003 by the Harvard School of Public Health and the Kaiser Family Foundation found about 80% of seniors 65 or older viewed it favorably. That was before the privatizers went to work and made it virtually impenetrable.

And when it dawns on seniors that they are actually paying to undermine the program they so admired, look for fireworks.

Gilbert Cranberg is former editor of The Des Moines Register's editorial page