On the Horizon
Crazy from Too Much Choice
By Robert Hayes, MRC News, Winter 2004
Last month Congress added a drug benefit to Medicare that beginning in 2006 will help some people and ensure that the American consumer (and taxpayer) continues to pay 50 percent more to drug manufacturers than the rest of the developed world does.
The House of Representatives approved the legislation by a hair at five a.m. on a wintry November Saturday. The Congressmen and women stayed up all night–it took that long for the House Speaker to find enough House Republicans to change their votes and support the legislation.
What went unnoticed is that the House vote came on the 40th anniversary of the death of the author of Profiles in Courage, JFK, the President who tried and failed to enact the Medical Care for the Aged program in 1962. Three years later, after the death of a president and the landslide election of 1964, it was left to President Lyndon Johnson to sign Medicare into law.
Only after President Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as the law is called, did most members of Congress begin to appreciate some of the finer points of the law they had just made.
That was understandable: the House roll call on the 681 page legislation began 24 hours after the bill itself was printed. Say what you will about the House of Representatives, it does not have a lot of speed readers.
So what hath Congress wrought? It’s hard to know where to begin.
Much has already been said and written about the parameters of the drug benefit, about the give-aways to drug and insurance industries, and about the welcome addition of some added coverage for preventive health care.
Too little has been said about the complexity of the legislation, complexity that will undermine any coherent administration of the law by federal and state agencies.
But our sympathies for the administrators are trumped by the fate facing people with Medicare. They will be overwhelmed by the complexity of decisions that the new system will force upon them.
First, Congress and the White House are pouring billions of dollars into private insurance companies, hoping these subsidies will attract private plans with benefits that will lure millions of people with Medicare away from Original Medicare. By next year, the government will pay private plans some 25 percent more than it would cost if those same members were in Original Medicare.
How will people with Medicare choose a private plan? Will they be willing to risk the changing benefit packages and closed network of doctors? Will they once more face private plans signing them up and then reducing benefits, dropping providers and adding premiums? Tough decisions.
Come 2006, when the newly enacted drug benefit kicks in, things will get more interesting. The legislation envisions an array of private sponsors of drug plans for people with Original Medicare, each of them offering different benefit packages covering different medications. The plans are expected to charge varying premiums, all with the flexibility to vary additional out-of-pocket costs.
It’s hard enough understanding these benefits when you know what your health care needs are. But the reality is that a health crisis is usually unexpected: today’s plan, even if you can understand it, may be largely useless tomorrow.
People with Medicare have plenty of legitimate gripes with the Original Medicare program. Coverage of prescription medicine is long overdue.
But once men and women are faced with the choices they have to make under this new law, there will be even more frustration and anger. And the most vulnerable will inevitably lose out on the health care coverage they desperately need.
AARP endorsed this legislation and many believe it gave the Congressional leadership the edge needed to win passage.
My mother quit AARP as a result of the endorsement. She has always been ahead of the pack.