WASHINGTON — With the first enrollment deadline a week away, the Medicare prescription benefit apparently is achieving its primary objective: helping millions of Americans get protection they did not previously have against one of the most draining problems of growing older.
By the May 15 deadline, federal officials expect to have more than 20 million seniors enrolled in plans under Medicare Part D, as the benefit program is called. That would include at least 7 million who previously lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year or more.
That's a considerable achievement for a government that has not tried to roll out such an ambitious entitlement program since the days of Lyndon B. Johnson. It's especially so for President Bush, who is no fan of big government.
Even some of the program's critics have given up trying to repeal it, while vowing to make it better.
And the performance of the drug plan, offered through private insurers, goes well beyond benefits for today's seniors. The plan is a test of Bush's idea that, instead of creating new federal bureaucracies, Washington can use businesses, informed consumers and market competition to solve knotty social problems such as access to healthcare -- potentially for all Americans.
"This is the first full test of competition in Medicare," said Joseph Antos, a health policy expert at the American Enterprise Institute, a conservative think tank. "It's also a test of consumerism in healthcare."
So if Medicare Part D is meeting its goals and helping millions of elderly Americans, why isn't it being hailed as an unqualified success?
For one thing, the system remains so complex and hard for seniors to navigate that many have yet to enroll, including about 2 million who live near the poverty line and would benefit from its subsidies.
More important, Part D may not be working so well for a substantial minority of patients -- seniors with complex illnesses and those requiring relatively expensive medicines. These patients often face high costs under the new program that threaten to put needed treatment beyond their reach.
A recent poll for the Kaiser Family Foundation found that 19% of enrolled seniors said they expected their medications to cost them more under Part D, compared with the 55% who said they would save.
