[Mb-civic] Building on FDR's legacy for senior citizens - James Roosevelt Jr. - Boston Globe Op-Ed

[William Swiggard]

  Building on FDR's legacy for senior citizens

By James Roosevelt Jr.  |  January 14, 2006  |   The Boston Globe

IN 1935, President Franklin D. Roosevelt signed the Social Security Act 
into law. He believed that it had to be simple, guaranteed, and fair. 
Designed to liberate senior citizens from the fear of want, Social 
Security has helped cut the portion of older Americans living in poverty 
by 84 percent.

In 1965, passage of Medicare and Medicaid marked the second most 
significant improvement of that century in health security for older 
Americans. In our own century, as medical research has developed a broad 
spectrum of lifesaving drugs, Medicare beneficiaries are confronted with 
a new fear: that necessary drugs are unaffordable.

The new Medicare prescription drug program (Part D) is designed to 
address this fear. It became effective on New Year's Day, and it marks 
the most significant change in federal health policy for seniors since 
1965. Will it live up to its promise in the way that the initiatives of 
1935 and 1965 have helped older Americans secure the basic necessities 
of life?

As a lifelong Democrat and president of a comprehensive health plan, I 
am well aware of Medicare Part D's flaws. There have been some 
well-publicized glitches in the initial implementation of the plan. 
However, the plan has been in effect for only a few weeks. Medicare Plan 
D still represents a major advance in coverage for seniors, and many of 
its problems can be corrected.

The most common complaint about the drug law is its complexity. A 
December survey of new Tufts Health Plan Medicare members in 
Massachusetts bears this out, finding that 50 percent understood the new 
Part D program ''not too well" or ''not well at all." While there is 
still too much confusion, these results mark an improvement over 
October, when the Kaiser Family Foundation and Harvard University found 
that 61 percent understood the plan ''not too well" or ''not well at 
all." Our survey confirmed exactly what one would expect from any 
complex change -- that with time, research, and a lot of counseling, 
seniors are gradually coming to understand and get comfortable with the 
plan.

If additional time is what some seniors need to make an informed choice, 
why not extend the period for open enrollment beyond the arbitrary May 
15 deadline? (After that, Medicare beneficiaries must pay 1 percent more 
premium for every month they delay Part D enrollment) Give seniors the 
full year of 2006, without penalties and restrictions, to make a choice 
or to switch plans if they are unhappy with their initial selection. 
Seniors should not be punished for being confused or afraid; they need 
more assistance in this transition.

In the meantime, the federal Centers for Medicare and Medicaid Services 
should revise its Part D brochures and its website so that crucial 
information is readily available and accurate. Furthermore, why can't 
the Centers for Medicare and Medicaid Services compare for its 
beneficiaries the cost and benefits of the drug plan options it offers?

The market needs time to sort itself out. Competition affords seniors 
some flexibility in selecting plans that are tailored to their needs. 
Sure, having an overwhelming number of options is confusing 
(Massachusetts seniors can choose from more than 40 coverage plans). But 
the good news is that over time, as typically occurs in new markets, the 
best offerings will emerge, reducing confusion in favor of the most 
popular, valuable plans.

If this doesn't occur, Congress should authorize the Centers for 
Medicare and Medicaid Services to limit the number of plans available. 
Just as private employers offer their employees a select few health care 
options, the Centers for Medicare and Medicaid Services could establish 
criteria, tied to enrollment, satisfaction and fiscal stability, for 
remaining in the program. In this way, seniors will feel confident that 
the coverage they select is secure.

The prevailing wisdom that the prescription drug law is too complex and 
markets do not work in healthcare threatens to become a self-fulfilling 
prophecy for many seniors. While 11.6 million people nationwide are now 
enrolled in Part D, 10.6 million of those enrolled were Medicaid 
recipients who were automatically switched to Medicare.

Over time, the Centers for Medicare and Medicaid Services should 
regulate the competition it has created to serve consumers and should 
guide its beneficiaries toward value, rather than push them into 
uninformed choice.

If in doing so, Congress is guided by principles of fairness, 
simplicity, and guaranteed coverage, it can build upon my grandfather's 
legacy.

James Roosevelt Jr. is president and CEO of Tufts Health Plan in 
Massachusetts and former associate commissioner of Social Security.  

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/01/14/building_on_fdrs_legacy_for_senior_citizens/
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