Too much of a good thing

November 15, 2005

Republicans in Washington have been operating for years on the assumption that Americans are enamored with choices, particularly when it comes to health care.

They seem to have swallowed their own political spin, which touts greater choice as justification for shifting away from one-size-fits-all government programs in favor of the private market.

Their theory faces a stiff test today as elderly Americans begin grappling in earnest with the nightmarishly complex web of choices for purchasing prescription drug coverage through Medicare.

Messy legislative horse-trading and the nimble flexibility of private entrepreneurs combined to shape the most ambitious federal benefit program enacted since the 1960s into a Rube Goldberg-like structure that defies easy navigation for anyone - much less for the elderly and often impaired group at whom it is aimed.

It should soon be abundantly clear to lawmakers hoping for re-election next year that the drug benefit program desperately needs to be retooled. In the meantime, though, Medicare beneficiaries and their families, friends and advisers must muddle through the maze and make a choice as best they can or face a potential penalty.

For low-income people with high drug costs and no current coverage, the new program should be a big help. People in that category should sign up before Jan. 1, 2006. Beginning today, enrollment can be conducted by telephone or over the Internet directly with Medicare. Assistance is available through state and local government agencies and private advocacy groups. Applicants need to be armed with personal information, but none should be offered to telephone solicitors.

Medicare beneficiaries who have drug coverage through former employers probably don't need the new benefit. But they have until May 1, 2006, to consider their options and enroll without penalty.

Chief among the required fixes to the program is allowing Medicare to use the bargaining leverage of its 40 million beneficiaries to negotiate drug prices with pharmaceutical companies. The program as constructed is paying way too much for way too little in direct benefits to seniors.

Much more also needs to be done to make the benefit program comprehensible to its users. No doubt a cottage industry of consultants will soon arise offering enrollment assistance services for a fee, just like tax-preparers. But as President Bush and Congress are already hearing, a new program that rivals the infinite permutations of the federal tax code makes one-size-fits-all look mighty attractive.

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