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MELISSA BLOCK, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

Today is the start of the annual six-week open enrollment period for people on Medicare. It's at this time that they can join or switch drug plans for 2008. There are more than 24 million Medicare beneficiaries now enrolled in a Medicare Part D plan. Of those, about 17 million are in a separate prescription drug plan. The rest - eight million or so - are in a Medicare managed care plan that includes drug coverage.

Commentator Douglas Kamerow is a former assistant surgeon general. When he tried to help his mother set up her system, he found it virtually impossible to navigate.

Dr. DOUGLAS KAMEROW (Former Assistant surgeon General): I don't have Medicare, yet, but my mother does, so I offered to sign her up online. It shouldn't be too hard, I thought. I'm a reasonably smart guy, I'm good with computers, and I'm a doctor so I know the lingo. I knew what to do. Gather up her Medicare card and list of medicines, go to Medicare's Web site, enroll the requested data, and pick the plan that gave her the best deal on prescriptions.

Guess what? It's not that simple.

I typed in her zip code and found that no fewer than 52 plans were available. They all had different premium prices, deductible levels and coverage policies. These are all displayed for you in endless tables on your screen. But these tables don't tell the whole story. Your best deal also depends on the number and type of drugs you're taking, whether they're available generically, and how each plan ranks your drugs in a four-tiered pricing scheme. And of course, all of this is superimposed on the flow of benefits through the year that Congress mandated.

You may remember hearing about this. First, there's a deductible period where you pay everything. Then, the plan pays a lot for a few months. Then, you fall into this so-called donut hole and you pay everything. Finally, if your drugs cost more than $4,000, the plan starts paying again. Simple, huh?

If you think this is a scheme that cries out for a spreadsheet, you're right, because what you really want to know after you jumped through all these hoops is, what will each plan cost me for years' worth of my drugs? And to give them credit, the folks at Medicare have provided an online calculator that will, more or less, tell you just that after you answer a bunch of questions, after you enter all the drugs and dosages, and assuming it's working, which it wasn't the first time I tried.

But even a list of drug plans ranked by their total cost doesn't tell you which one to choose. Should you take a program that pays for drugs in the donut hole in case your doctor adds some expensive medicines during the year? What's the relative importance of having a lower deductible versus lower monthly premiums and so forth? All of which is to ask what in the world was Congress thinking when they created this mess?

If I'm having so much trouble picking the best program for my mother, how are the vast majority of Medicare patients ever going to pick their plans? Who could possibly benefit from these arcane set of rules and regulations.

Here's a hint: It's the same people who lobbied for this crazy system two years ago and the same ones who raised premium cost, an average of 27 percent for 2008. You guessed it. It's the health plans and the drug companies.

NORRIS: Family physician Douglas Kamerow is a former assistant surgeon general and a health services researcher and columnist. He lives in Maryland.

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