- The Washington Times - Sunday, November 20, 2005

Last week seniors began enrolling in a Medicare drug-benefit program of their choice. Seniors can pick from nearly 40 different benefit plans with different deductibles and co-pays, and a range of medicines are covered. They can get their prescription drugs from the traditional Medicare plan, from a Medicare managed-care plan or their employer.

Media reports have depicted the program as confusing. That’s insulting to the millions of seniors who have managed to make hundreds of important if not life and death decisions throughout their lives. The process of choosing and the range of choice are not daunting. Indeed, seniors face the same panoply of plans when they pick a cruise, an IRA or where to retire. Rather, it is the ease of comparison and the quality of choices that will determine whether or not the program is successful.

Earning the trust of consumers and successfully weathering the inevitable political attacks that emerge this year will require that Medicare address three factors on which success depends.

First, Medicare administrators have indeed made the decision about drug benefits more complicated than necessary. Early on, an HMO executive remarked that Medicare was drowning people in information about the program. That’s about right. The best comparison of benefit plans is pharmacychecker.com. It gives you information about the premium, co-pay and percent of top 100 drugs covered by plans with pharmacies in your area. Since you can change your drug plan once a year, there’s not much more you need to know to make a decision. Medicare should scale back the amount of information it is giving out and put more effort into encouraging others to come out with their own comparisons.

Second, Medicaid and Medicare director Mark McClellan should reverse a disturbing trend on the part of drug-benefit plans to skimp on new medicines even before the program starts. Plans are in the works to try to shift seniors from existing drugs to generic medicines. This might save money on prescription drugs, but restricting seniors to generic versions is associated with higher overall health-care spending. Drug plans should be required to demonstrate to consumers that they are contributing to the better health outcomes or at least not hurting them with their formulary lists. Drug plans should not delay in making a new medicine available after the Food and Drug Administration approves it.

Third, and most problematic in this regard, the new Medicare law has established a troubling precedent by allowing drug plans to refuse to pay for an important category of new medicines: drugs that treat eating disorders or help treat metabolic diseases. The restriction, which was lobbied for by the drug plans themselves, makes a mockery of statements by McClellan spokesman Gary Karr, who said: “The law says if it’s an FDA-approved drug and it is medically necessary, it has to be covered.” Obesity is often a side effect of other medications that are medically necessary. Medicare patients who are morbidly obese cost the program 35 percent more than patients who are not. The disease is associated with a higher incidence of diabetes, atrial fibrilliation and cardiac arrest, all of which cost Medicare a bundle. It complicates the treatment of arthritis, osteoporosis and lupus. Failure to gain weight is a leading cause of death among seniors suffering from mental illness. And sadly, a large percentage of all women who die from anorexia are women 50 and older, even as the number of older women with eating disorders continues to rise.

Dr. McClellan has said in the context of gastric bypass surgery, “What matters is whether there’s scientific evidence that an obesity-related medical treatment improves health.” Yet, without resort to similar evidence, Medicare has outlawed paying for medicines that treat anorexic women and people with metabolic disorders even though such medications can save their lives and reduce Medicare spending.

Such rationing caused people to revolt against managed-care plans in the ‘90s. They will trigger bad press and attacks against drug plans and Medicare in the year ahead unless the administration stays ahead of the curve. Don’t expect anything principled from Congress in this regard. The necessary leadership on the drug benefit boils down to deciding whether the Bush administration wants to treat the elderly as customers or recipients. As the late management guru Peter Drucker observed, customers only pay for what is of use to them and gives them value. Nothing else constitutes quality.

In contrast, recipients in a government entitlement program are an afterthought and program managers largely react to lobbyists and micromanage every decision with respect to cost, not quality.

People (taxpayers included) are going to be paying good money for the drug plans. Giving them value for their dollar should be the only thing that matters.

Robert Goldberg is director of the Manhattan Institute’s Center for Medical Progress.

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