The Medicare Drug Plan:

A Dose Of Confusion

It is the biggest federal entitlement program since the 1960s, expected to cost $724 billion over ten years. Yet when senior citizens started enrolling this week in the new Medicare Prescription Drug Plan for coverage beginning on January 1, the process seemed to be more of an affliction than a remedy for their anxieties about drug costs. In Newtown, and across the country, the enrollment process was proving to be hopelessly confusing and complicated, not only to the elderly, but to those family members, friends, and social service experts trying to help them understand it.

The frustration and confusion was so bad among seniors that staff members of the Newtown Senior Center and Newtown Social Services Department were advising local elders this week not to sign up immediately but to wait until everyone has better information about the advantages and drawbacks of the 17 plans and 44 options available to Connecticut residents on Medicare. With monthly premiums ranging from $7.32 to $65.58, some with subsidies, some without, some with deductibles, some without, some offering nearly all popular drugs, some not, some offering mail delivery, some not, the process of selecting the best individual option for each individual’s circumstance is daunting, to say the least.

It is hard to understand how an entitlement program so incredibly expensive can fall so short in delivering clear information and services to those who need them most. Aside from the confusion over the myriad enrollment options, the plan itself has a big hole in the middle — dubbed the doughnut hole — where benefits disappear after $2,250 in cumulative drug expenses and do not reappear until an individual’s drug costs reach $5,100. It’s not a problem if you are healthy enough to stay out of the doughnut hole, but when you are sick, needing more drugs, and presumably more help with your drug bills, that is when the plan pulls back on benefits.

And don’t try to purchase supplemental insurance to see you through the doughnut hole — it’s not allowed. The plan also specifically prohibits Medicare from using its dominant position in the drug marketplace to negotiate lower prices from the drug companies. So many of the provisions and caveats of this program appear to be more concerned with benefits that accrue to the private insurance companies that administer the various plans and pharmaceutical companies that provide the drugs than to the elderly who need help paying for their medications.

Everyone knew that providing a drug prescription plan for senior citizens through Medicare would be an expensive proposition. But it is what people wanted, so a group of politicians who were not ideologically predisposed to creating big government programs found themselves in the position of having to propose one in order to get elected. From the beginning it was a more of a political promise than a social compact. In the end we have the expedient political solution and a nation of very confused and frustrated senior citizens.