Medicare Rx Benefit Needs High Turnout for Success

Three weeks into the new Medicare drug benefit, federal officials are still scrambling to fix problems with its rollout. Things are improving somewhat, say pharmacists and patient advocates. But now some worry that the program's short-term problems could jeopardize the program in the long-term.

Q & A: Navigating the Program

Even with improvements, people are still having trouble getting their drugs, says Vicki Gottlich of the Center for Medicare Advocacy, who has spent much of the week counseling the people who counsel Medicare beneficiaries. "They are still very, very frustrated. In fact somebody on our call yesterday was in tears," she told a forum sponsored by the Kaiser Family Foundation.

That could spell trouble down the line if seniors don't sign up for the new Medicare Part D drug program because they see their friends and neighbors having a hard time. That may be one reason why Health and Human Services Secretary Mike Leavitt has been touring the country to explain how Medicare is working to address the problems. "The measure of success isn't whether we reached perfection on the first day, it's how we respond to the inevitable, unpredictable problems, and we are," he said in a stop on Capitol Hill to brief members of the Senate Finance Committee. "The plan is improving every day," Leavitt insisted.

And in a conference call with reporters earlier this week, Leavitt said new enrollment numbers show the efforts are working. "In the last 30 days more than 2.6 million people have enrolled in the plan, bringing the total to 24 million," he said. "We're on track to meet the 28 to 30 million goal this year."

But others say those numbers aren't as impressive as they sound. "They talk about well on their way to 30 million being covered," says Robert Laszewski, a political analyst and insurance industry health consultant, "but in fact 22 million people already had drug coverage before Part D went into effect."

Laszewski says the more important statistic is what the 21 million Medicare patients who didn't have drug coverage have done. "Only 3.6 million have signed up through Jan. 15. that's only 17 percent. And that's after more than 2 months of hype, of advertising, of the president going around the country giving speeches about it," he says.

In fact, judging from the early signup, Laszewski says he thinks the program is on track to enroll between 30 and 40 percent of seniors who previously lacked drug coverage, "and that's certainly not a public policy success. It's clearly not a political success for the president and Republicans because so many seniors are upset about the way this thing's been handled."

And Laszewski says the program could be on its way to being a business failure as well. "Because it's important in a voluntary program like this to get a good cross section of people, the sick and healthy both, coming together to finance the program. If we're geting just 30 to 40 percent of seniors, chances are we're getting just the ones who think they can make money on it, which means the insurance companies won't make money on it," he says.

But Medicare officials say they remain confident about the program's future. Leslie Norwalk, deputy administrator of the Centers for Medicare and Medicaid Services, told the Kaiser Foundation forum yesterday that the Medicare program itself suffered some of the same growing pains when it began 40 years ago. "We probably have a stack over a foot long of newspaper articles between 1965 and 1966 that read almost identical to the articles we see on the front page of every paper today about the difficulty of implementation and confusion and so forth," Norwalk said.

Meanwhile, in the short term, there's concern that the implementation difficulties could make it harder for President Bush to push further plans to make the health care system more market-driven. Sen. Ron Wyden (D-OR) voted for the Medicare law and supports a stronger role for the private market in health care. But he says the administration has bungled the Medicare drug rollout. "The way they've done this in the beginning, has really damaged the cause of a private role in American health care, and it didn't have to be this way," he said.

President Bush is expected to unveil new plans to encourage a more active role for individuals in purchasing medical services in his State of the Union speech Jan. 31. Democrats, meanwhile, say they'd rather he talk about ways to fix the Medicare drug program already under way.

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