One recent afternoon in Los Alamitos, I watched Marcy Zwelling-Aamot, M.D., pick her way through a government website designed to help elderly patients select the right Medicare drug plan, based on their prescription needs and hometown.
The website, created for the launch of Medicare's new prescription drug benefit, identified 48 individual plans available for Southern California residents. All were sponsored by private health insurance companies administering the government drug benefit for a profit. The plans' monthly premiums ranged from $5.41 to $66.08; their lists of covered drugs differed from one another, sometimes significantly; and all imposed different annual out-of-pocket costs on enrollees -- a critical consideration for patients on fixed incomes.
Zwelling-Aamot is a private internist who accepts a limited number of patients but places herself at their beck and call. She and her staff have spent months helping her patients navigate the new benefit, a process that requires at least an hour and a half of research per patient (time for which she's not compensated by Medicare). Like many other health professionals who have become familiar with this program, she has come to see it not as a boon for elderly consumers, but as a scandal.
"As a patient, you are totally hoodwinked by this system," she told me. "It's not just an economic tragedy; it's a moral tragedy."
The Medicare drug benefit is shaping up as the single most cynical scam perpetrated by the Bush administration on American consumers. Designed to maximize profits for drug makers and health insurers, the program was launched so ineptly Jan. 1 that hundreds of thousands of patients have been prevented by computer glitches from filling their prescriptions. California and 25 other states have had to step in temporarily to pay for improperly rejected prescription claims.
Thus far, the most seriously affected patients are those enrolled in both Medicare, which covers the disabled and people over 65, and Medicaid, which covers the poor (known in California as Medi-Cal). Unlike Medicare-only members, for whom the new benefit is voluntary, these patients were automatically enrolled in the new system as of Jan. 1.
But their difficulties are the tip of the iceberg. Some Medicare patients will find that their prescription costs under the new program will actually be higher than before, in some cases rising beyond their ability to pay. Others will be so confused by its unnecessary complexity that they may avoid enrolling at all.
The program is ostensibly tailored to serve up to 43 million elderly Americans, most of them subject to an enrollment deadline of May 15 and a stiff financial penalty for late enrollment. Yet, most seniors seem to be biding their time; Medicare says that only 3.6 million people, out of an estimated 18.3 million who are eligible for the stand-alone benefit, have signed up thus far.
Why are people holding off?
Even the government acknowledges that selecting a plan is dauntingly confusing for those without access to its Internet help site. That's a big hurdle, because an estimated 70% of Americans over 65 have never been online.
The toll-free information lines set up by Medicare and various health plans have been overwhelmed for weeks. Medicare regulations discourage physicians, pharmacists and healthcare advocates from helping patients select a specific plan. Yet many professionals say they themselves are so confounded by the program's intricacies that their patients will be hard pressed to make the right choices on their own.
The health plans have filled the vacuum with glossy marketing brochures, some of which are flagrantly misleading. "You're pitting big corporations against the most vulnerable people in society, and you're telling them that they can't turn to the people they trust for advice," observes Thomas R. Clark, director of policy and advocacy for the American Society of Consultant Pharmacists, an organization of pharmacists specializing in geriatric and long-term care.
It's worth remembering that the prescription drug program was born in an act of fraud. The Bush administration sold it to Congress in 2003 by estimating its cost at less than $400 billion over 10 years. Scarcely a month after its enactment, the White House issued a new estimate: $535 billion. That figure might well have killed the bill, which had passed the House by a razor-thin margin even with the lower price tag.
It soon came to light that Richard Foster, Medicare's chief actuary, had known of the higher estimate -- but had been told he'd be fired if he warned Congress before the vote. (The current estimate is $700 billion.)