Most partisan liberals and conservatives are in need of a reality-prescription to clarify their approach to the new Part D Medicare prescription drug benefit. This is a classic polarized left-right ideological confrontation that neglects the interests of the vast middle.
Medicare did not cover prescriptions. Neither did Medicare Gap supplements or HMO’s Medicare Advantage substitutes cover more than a few thousand dollars worth from a limited formulary. Meanwhile, the population is aging, the cost of wonder drugs increasing, and company retirement benefits disappearing under the weight of costs.
Fiscal conservatives decry the enormous budgetary costs of the program and fear Democrats greasing a slippery slope to greater costs and government controls over medicine. Some budget watchers would restrict it to the poor. Although it may sound like much, the few percent with more than a million or so of assets needed to sustain a middle-class lifestyle on the coasts can be decimated by such costs.
Liberal Democrats oppose the program’s reliance on private insurers regardless of increased budgetary and personal costs of a government-administered program. The very thought of a private-enterprise solution sends them into paroxysms, especially when the success of this government-private alliance can point the way to other cost-effective privatizations of government-run programs.
Democrats prefer a government-administered benefit that provides a much wider range of drugs uniformly to all, rather than the various formulary and consequent premium varieties offered by insurers that Medicare beneficiaries choose to meet individual circumstances. Democrats prefer the government to directly negotiate prices with pharmaceutical companies, regardlessthat would lead to price controls and stifling innovation. And insurers usually have more bargaining weight through larger purchasing power. Democratic critics ignore that Part D has met aggressive enrollment goals and that insurer competition drove premiums well below those expected.
The strongest argument raised by liberal Democrats is aimed at the very core strength of the Part D program the competition among insurers, to focus on the difficulties of choice for many seniors among the wide variety of offerings. Part D insurers provide an array of plans, with differing formularies and premiums, as long as it contains base drug coverages for each of many conditions. Appeal rights are provided for exceptions.
Congressman Henry Waxman, leader of those favoring government-run medicine, requested studies by the Congressional Government Accountability Office that last May reported the Medicare phone and Web sites failed to provide information that was “consistently clear, complete, accurate, and usable,” and in July that the insurers’ phone lines “did not consistently provide callers with accurate and complete information.”
As The Washington Post reported:
Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, said investigators asked customer service reps for information that they are not required to provide, and may even be prohibited from providing.
“Medicare has never required drug plan call centers to provide detailed information about the prices of specific combinations of drugs,” he said. “Despite this fact, two of GAO’s five questions were on this topic.”
McClellan might have added that IRS phone line advisers have as poor a record for accuracy or completeness, and that’s for a program dealing with clearer financial transactions than the foggier questions of which combinations of which drugs are best or most cheaply covered.
Nonetheless, one mayreasonably argue that matters of one’s physical health should require greater and easier access to reliable information and guidance than matters of one’s financial health.
There is a practical solution, at least to contending politicians who care more for that than polemics: Have Medicare provide primary care doctors a half-hour “consult” fee to search the Medicare prescription plan comparison site for the plans that contain the mix of present and prospective drugs that best fit their patient’s medical requirements. The attending doctor is best suited to know, has the intelligence, experience with various insurers’ quality, and — particularly in this age of group medicine and sophisticated information systems — the means to decipher and recommend.
Doctors aren’t financial advisers, and can’t analyze the effect of differing premiums on patients’ assets and lifestyle. However, most patients are more financially self-attuned than given credit for, and do share their financial concerns with their doctors. At least, more reliable Part D plan information will be received, and the financial choices by individuals be clearer and more self-responsible.
One may argue that many doctors are too caught up in a big pharma-led conspiracy or fascination with the latest, marginally more effective but more costly drugs. If so, that tendency would actually be restrained by facing the patient with questions of cost-effectiveness.
Doctors are always searching for treatment codes to enlarge their income. Patients are always searching for reliable, authoritative and personalized care. It’s time polarized politicians agreed to improve on the Part D program to at the same time increase its success and remedy its attendant confusions.
Bruce Kesler blogs at Democracy-Project.com, and owns an employee benefits consulting and brokerage firm in Encinitas, Calif.
