Vexing rollout of drug plan

Seniors face a steep learning curve with Medicare program.

Aboard a big bus emblazoned with "Help Is On The Way!" Health and Human Services Secretary Mike Leavitt is matter-of-fact about criticisms of the US government's new drug program for seniors.

"Healthcare is complicated," he says, as the red, white, and blue bus wends through Manhattan streets. "But so is signing up for cable TV or having to license your car."

This week, as America's seniors begin enrolling in the Medicare prescription-drug benefit, Mr. Leavitt is visiting his 53rd city since June in this rolling Medicare-outreach station. Stopping at one senior center after another, he delivers a practiced message: The program can help almost everyone over 65. All they need to do is call 1-800-Medicare or visit the website www.medicare.gov. Help might also come, he says, from your doctor or grown children.

The trip is part of an ongoing government effort to educate seniors - as well as their adult children, city employees, healthcare workers, nonprofit groups, and anyone else in regular contact with Medicare recipients who might help them navigate this new bureaucracy.

The drug plan, called Part D, is the most significant change to America's healthcare system for elders in 40 years. As such, it has been criticized for being too difficult to navigate: More than 60 percent of seniors don't understand the program, a recent survey found. And more than 40 percent say they don't know if they'll even bother to enroll because they're not sure it will help them. Some seniors have as many as 40 drug plans to choose from, each with a different premium, co-payment, and list of covered drugs.

Advocacy groups filed a lawsuit Monday alleging that the changes might cause some seniors who also have Medicaid to lose coverage for some drugs.

What is most needed, healthcare experts say, is grass-roots outreach that can provide much more one-on-one counseling for the 28 million to 30 million seniors expected to enroll in the plan over the next six months. In the past, the government has used that approach to handle major changes to Social Security, they say.

"When there would be changes, they'd staff up the Social Security offices. Every congressman would staff up the office. Every mayor had a Social Security specialist so at the local level they could help people see how their benefits changed," says Robert Blendon at the Harvard School of Public Health, who conducted the recent survey of seniors for the Kaiser Family Foundation. "The aggregate long list of choices - calling an 800 number, going to a website - is just very hard for seniors."

Critics attribute the program's complexity to Congress's decision that private insurance companies will administer it. To encourage the companies to offer the drug-benefit plans, Congress offered them taxpayer-funded subsidies. That's a giveaway, critics say, that will ultimately make the program more expensive in the long run.

Leavitt dismissed those concerns Monday, saying competition among providers has already helped to bring down prescription-drug prices 15 percent. "That's the free market working," he says. He acknowledges, though, that the program will work best if more people opt to enroll.

His New York tour offers an example of the challenges posed by the "understanding gap" among seniors. But it shows, too, that community groups have made strides in their efforts to provide one-on-one contact for seniors.

An estimated 1.1 million New Yorkers, who speak as many as 180 languages, are eligible for the new drug benefit. Mayor Michael Bloomberg has enlisted most city departments, as well as any nonprofit center willing to pitch in, to help seniors get the answers they need.

"We are opening 38 local enrollment centers in each borough of New York City that will have the ability to work with people in their own communities in over 18 languages," says Edwin Mendez-Santiago, commissioner of the city's Department of the Aging.

One enrollment center is at the Open Door Senior Center in Chinatown. When Leavitt arrives, hundreds of elderly residents, most wearing red Open Door T-shirts, are waiting in neat rows. Many also have earphones for simultaneous translation, because they don't speak English. To ensure a big turnout, Leavitt has brought along a superstar of sorts in the Chinese-American community - Labor Secretary Elaine Chao, the first Chinese-American woman to hold a Cabinet post.

"A lot of ethnic communities are underserved, and the Asian-American community is certainly one of them," she says later on the bus, explaining why she came.

The tour has had its challengers. Protesters outside the Open Door center held signs that read, "Part D = Difficult" and "Part D = Daunting."

"I was in the insurance business for 25 years," says protester Genevieve Cervera. "When people say to me, 'Tell me about it, you were in the insurance industry,' I say, '... I don't have a clue.' "

Inside the center, many were just as puzzled. Suleika Cavrera of the Institute for the Puerto Rican and Hispanic Elderly came to learn more so she could be more effective in her work. "It takes an hour or more to engage each person to give them the information they need," she says, noting that her group serves 100,000 people. "And if you multiply that, how many people can we serve adequately?"

Leavitt is confident it can be done.

"There's an old Asian saying: 'One time doing is better than 100 times hearing,' " he says. "We're in the stage now that people just need to do. Then it will become evident that this is manageable."

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