Medicare Reform Confusion
Today’s New York Times carries a piece on the latest reforms to the US Medicare programme. They are based around the introduction of drug discount cards, ‘a 19-month stopgap measure to provide discounts of 10 percent to 25 percent for Medicare participants who have no other prescription drug coverage. In addition, low-income participants are eligible for subsidies of $600 a year’.
Several features are of note:
(1) As part of Bush’s drive to increase the marketisation of welfare services, some 73 competing plans are available ‘each providing different savings on different medications, and all subject to change’. The obvious by-product of this is - as the NYT report - confusion in the face of this complexity.
(2) In an attempt to help potential recipients manage this complexity, e-government applications have been thrust forward. The medicare website offers a tool for interrogating the different schemes. It allows medicare recipients to compare prices offered by the different programmes for their prescriptions and a similar service is available from a freephone call centre service. However, its critics - including some of the companies behind the cards - have complained that the pricing information is inaccurate - and that some schemes are absent altogether. Meanwhile, the NYT claims that:
For many retirees, it is too much.
“I’m 85, do I have to go through this nonsense?” asked Florence Daniels, a retired engineer who said she received less than $1,000 a month from Social Security, of which she paid $179 a month for supplemental medical insurance. She gets drugs through a New York State program, which provides any prescription for $20 or less. To make ends meet and afford her drugs, she said she bought used clothing and put off buying new glasses. Some of her friends travel by bus to Canada to buy drugs; others do without, she said.
Ms. Daniels did not use the government Web site to compare drug cards, in part because she cannot afford a computer. “I’m trying to absorb all the information, but it’s ridiculous,” she said. “Not just ridiculous, it’s scary. If there was a single card and it was administered by Medicare, and it got the cost of drugs down - wonderful, marvelous. But with these cards, the only thing we know is that we’ll have to pay money to other people to administer what we can get and can’t get.”
(3) In any event, the information is likely to be of limited use in some cases, for card providers are at liberty to change their prices - and the drugs they supply - at any time, while medicare recipients are only entitled to change their card once a year. As one medicare recipient told the NYT: “What if I chose one? They could drop my drugs two weeks later.” In such cases, perversely, the e-government application could do little more than inform the service user of how they are missing out: information would be far from empowering.
(4) Given this, according to the NYT report, many in need of assistance are likely to reject the plan out-of-hand, not least because better deals are often available on the internet, particularly if drugs are ordered from outside of the US.
