Drug card debacle shows that more can be less

May 17, 2004|By Ellen Goodman

BOSTON - The next time the government comes up with a program for senior citizens, may I suggest testing it on some human subjects? If the planners can't find any elderly volunteers, I could lend them some of my nearest and dearest.

The plan that is up and (not) running now is something just short of a disaster. The administration decided to offer discount drug cards as an election-year party favor to Medicare recipients waiting for the prescription drug plan to begin in 2006. Folks 65 and over were told they could pick the best deal from a list of competitors, pay an annual fee and save as much as 25 percent on pills. Nothing to it.

On sign-up day, we saw an upbeat Senate Majority Leader Bill Frist comparison-shopping his cheery way across the government Web site. After clicking A for Allegra, he declared: "Now this is pretty amazing."

Alas, "amazing" is not the word most seniors are using. Try "overwhelming," "confusing," or "frustrating." As one 91-year-old in Cleveland told a reporter, "You'll have to hire a $500-an-hour attorney to find out if you'll save 5 cents."

The Web site is impenetrable (memo to the government: Only a quarter of senior citizens even use the Internet). The 800 number is so overloaded that it kept hanging up on me. And that's just the beginning.

All in all, there are more than 70 drug discounters each offering different prices for 209 drugs. Want Lipitor, Vioxx and Lotrel? You can check the prices at the discounters in your ZIP code, buy yourself a spreadsheet, and by the time you're finished, you'll need to add a little Xanax.

This not an ageist rant, though I would love to see Dr. Frist teaching my mother to use Excel. It is, rather, a consumer rant. What we have is another example of the marketplace view that more is always more.

The Bush administration has long preached the virtues of individual choices. It sees citizens as shoppers. It favors school choice. It favors letting some Social Security money be used for individual investment choices. But for every choice, there's a decision. For too many choices, there's a decision breakdown. We may shop but we also drop.

Not long ago, researchers found that shoppers are 10 times more likely to buy jam if there are six choices on the shelf than if there are 24.

Another study on 401(k)s showed something similar. The more mutual funds offered to employees in their retirement plans, the more likely they were to choose none of the above.

As Barry Schwartz, who wrote The Paradox of Choice, says, "The old argument is that the more choices you add, the more you improve the collective welfare. This turns out not to be true." There is a growing, rather subversive body of evidence that more may be less.

Too many choices can lead not only to paralysis, says Mr. Schwartz, but to dissatisfaction. We spend more time making decisions and more time worrying that we made a mistake.

Ask anyone who has ever thrown up his or her hands trying to pick a phone plan. Buyer confusion is followed by buyer remorse. The personal responsibility for making a choice is followed by the suspicion that someone, somewhere, got a better deal and there's no one to blame but yourself.

The discount drug plan is a near-caricature of the whole problem of too many choices with too many uncertainties. Those who are eligible not only have to comparison shop till they drop, they have to buy a card that commits them for a year but allows the company to change prices every week.

They may choose a company that has a good price on one drug, but then the doctor prescribes another. And at the end, there's still a chance for remorse if the savings are not as "amazing" as they'd get from an Internet site, a local drugstore or a bus trip to Canada.

More is also less these days because we spend more time as consumers, less as citizens. More time figuring the odds, less time protesting the oddsmakers.

If you think this is a mess, just wait 19 months until the new drug program clicks in and seniors get to pick their own insurance packages. Whoopee. Anybody want a jar of jam? How about 24 different jars of jam?

Ellen Goodman is a columnist for The Boston Globe. Her column appears Mondays and Thursdays in The Sun.

Columnist Cynthia Tucker will return next Monday.

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