The rollout of the biggest expansion of the Medicare program since its inception was greeted this week with the kind of political fanfare and controversy expected of a hot issue in a tightly contested election year. But it also engendered a healthy dose of confusion.
Millions of elderly Americans like Violet Versailles, who became eligible to sign up for the much touted new Medicare-sponsored drug discount cards, found themselves more puzzled than pleased. "I haven't been able to understand it," she says, filling small bags of candy for a Mother's Day party at the Hamilton Senior Center on Manhattan's West Side.
Calls to the toll-free help line 800-Medicare were regularly answered with: "All circuits are currently busy." The www.medicare.gov website raced to keep updated with the lowest prices offered by the approved card companies. And thousands of social workers and others who work with the elderly struggled to decipher which cards would help which of their clients - if any.
For supporters, the rocky start was a product of the inevitable glitches that come with the creation of a massive new program impacting 41 million Americans. But those advocates also see a success in the making, both in the savings that will come to seniors and in the price transparency already created by the competition between drug-card companies. Anyone can go to the Web now and see which companies offer the best discounts on prescription drugs.
Critics, on the other hand, see the whole effort as nothing more than a squandered opportunity. They contend the new benefit has created maximum confusion for minimal savings because the program is stacked in favor of the drug-card companies. In fact, they argue, the discounts are nothing compared with the lower prices that can be found on the Internet or by re-importing drugs from Canada - a movement that has only gained steam as dissatisfaction with the new program has grown.
But for those who work with seniors, the realities of the new prescription-drug benefit are getting lost in all the rhetoric.
"It's maddening to hear the political characterizations of the programs on both sides," says Robert Hayes, president of the Medicare Rights Center, a national consumer rights organization based in New York. "There is no mistaking that some low-income people will definitely benefit. But it's absurd for some Republican leaders to pretend that the discount-card program is anything more than a drop in the bucket."
The cards are only the first phase of a larger prescription-drug benefit that will kick in by 2006. They're a product of five years of political promises, a fiercely fought legislative battle, and a final political compromise last fall that left few satisfied. Many Democrats who voted for the compromise decided that something was better than nothing, and many Republicans supported it only because it introduced the free market into the Medicare system. So what emerged is a camel of sorts.
Medicare sets out requirements for the discount cards that private companies must meet, and then they market their cards to seniors, who can choose one. Very low-income seniors get an automatic $600 subsidy. For others, the discounts can range from 5 to 40 percent, depending on the card and the drugs ordered. Currently, more than 30 companies are authorized to provide the discount cards. Each one establishes its own prices and list of covered drugs.
It's up to seniors like Katharine Roberts to figure out what which one, if any, would be good for them. For now, she's taking a wait-and see attitude. And she's advising her elderly neighbors in her West Side apartment complex - where she's known as an "answer woman" on healthcare problems - to be cautious as well.
"My problem is this: You can only have one card, and that particular card may not cover all of your medications, especially if they're made by different pharmaceutical companies," she says. "And it may cover them one time and then, it may not the next time."
That's because the legislation allows card companies to change the list of covered medications and their prices weekly. But seniors can change cards only once a year. Advocates contend the card companies need that flexibility to negotiate the best prices, while critics say it's a bait-and-switch scam in the making.
"There are absolutely no restrictions on the pharmaceutical industry," says Edward Coyle, executive director of the Alliance for Retired Americans.
Supporters shoot back that the market will rein them in, and any company that isn't providing good service will alienate its customers and lose market share. "This creates real choice and real market competition for seniors," says Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation in Washington.
But down in Hollywood Beach, Fla., in the shade of palm trees where Marlene Wellington is chatting with friends, skepticism is running far higher than either relief or gratefulness.
Ms. Wellington, a retired licensed clinical social worker, says the program is far too complicated. "There are way too many choices," she says. "It's laughable in a sad, ironic way. Sometimes choices are not to your benefit."
• Jennifer LeClaire contributed to this report from Hollywood Beach, Fla.