[Mb-civic] A healthy Medicare drug plan - Boston Globe Op-Ed

[William Swiggard]

  A healthy Medicare drug plan

By Newt Gingrich and David Merritt  |  March 30, 2006  |   The Boston Globe

AMID THE SHRILL CRIES that the sky is falling on senior citizens comes 
news on how Medicare beneficiaries view their new prescription drug 
benefit. According to two recent surveys, conducted on behalf of 
America's Health Insurance Plans, of more than 800 randomly selected 
seniors enrolled in the Medicare drug benefit, 84 percent who signed up 
voluntarily experienced no problems enrolling; two-thirds say the 
benefits are worth the time and effort to evaluate their options and 
plans; 59 percent of self-enrolled seniors say they are saving money; 
and 90 percent of beneficiaries who were automatically enrolled, most of 
whom are poor, have had few problems getting their prescriptions.

The new Medicare prescription drug benefit is delivering on its promise 
of more choices at lower cost. But instead of championing the program's 
success, critics are desperate to find problems with what House 
Democratic leader Nancy Pelosi describes as ''this disastrous Republican 
Medicare prescription drug plan." With an overwhelming majority of 
seniors happy with their coverage, partisan critics have a new doomsday 
prophecy, the April 1 deadline when private insurers can stop paying for 
prescription drugs not on their formularies. Seniors are getting the 
medicines they need, and will continue to get them. Every plan is 
required to cover all medically necessary prescriptions. This means that 
a wide range of drugs, from chemotherapy drugs to antidepressants, will 
not be affected by the deadline. Plans also have extensive formularies 
that cover nearly all of the most commonly-prescribed medicines. For 
those medicines not covered, seniors can work with their physicians to 
find a generic equivalent or they can apply for an extension or 
exception and have an answer within 72 hours. No senior will go without 
the medicines their doctors prescribe -- and the majority of the costs 
for these drugs will be covered by Medicare.

Competition is driving down prices. Total federal spending will be 20 
percent lower than projections because seniors are shopping for plans 
with lower premiums. With a plethora of choices, seniors and their 
families have chosen wisely. Medicare estimated that monthly premiums 
for the new drug plans would be $37 a month. Competition and consumer 
empowerment have brought the price down to $25 per month. President Bush 
and Congress enacted bold reforms in 2003, but the transformation of 
Medicare must not stop here. Experts estimate that Medicare will have a 
shortfall of nearly $22 trillion in the coming decades. Clearly, it is 
the perfect opportunity to take the next step toward saving Medicare.

First, Medicare must effectively engage its beneficiaries in their 
health and healthcare through consumer-centric health plans. 
Tax-friendly accounts, like Health Savings Accounts, have had a dramatic 
impact in private sector healthcare in just two years. When consumers 
directly control their healthcare dollars, they are wiser purchasers and 
still get the care they need. Seniors deserve the same opportunities -- 
and benefits -- that more than 4 million other Americans now enjoy.

Second, to become wise consumers, individuals need information about the 
healthcare products and services they will purchase. Medicare will soon 
post the prices it pays for common medical procedures. But Medicare 
beneficiaries -- and all other healthcare consumers -- have the right to 
know not only the cost but also the quality of the physicians and 
hospitals they depend upon.

Third, Medicare should reimburse physicians, hospitals, and other 
providers based on the quality of care they deliver. In the current 
system, if patients are healthy, they don't see their doctors; and if 
they don't see their doctors, their doctors don't get paid. This 
perverse approach must change.

Last, Medicare must make health information technology an essential part 
of the program. Providers will deliver better quality care with 
technology, and health information technology will also empower 
consumers to manage their health better and more easily find cost and 
quality information.

These solutions will improve individual health, reduce costs, and build 
a brighter future for all Americans.

Former House speaker Newt Gingrich is founder of the Center for Health 
Transformation. David Merritt is a project director at the Center. 
America's Health Insurance Plans is a member of the Center.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/03/30/a_healthy_medicare_drug_plan/
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