The best thing that can be said for President Bush's latest effort to reform Medicare is that it isn't quite as bad as the earlier version. This time the president at least promises a vague prescription drug benefit for retirees who stick with the traditional fee-for-service Medicare program. But he would force recipients into private managed-care plans to receive adequate help with prescription drugs. That approach failed in the past and it deserves to fail again.
The Bush plan would give low-income retirees a $600 yearly drug subsidy. Those who stick with traditional Medicare coverage, in which they get to choose their own doctors, would be given a discount card worth at least 10 percent off drug prices. Catastrophic prescription coverage would kick in only after a recipient spent an as yet unspecified amount (likely to be several thousand dollars) on drugs. That would still leave many retirees with a significant financial burden.
To be eligible for a meaningful prescription drug benefit, retirees would have to give up fee-for-service coverage and enter one of two plans. Under Enhanced Medicare, a recipient would choose from a list of preferred provider organizations (PPOs). Bush likened it to the insurance benefit given federal employees. But the quality of such plans has suffered in recent years from increased costs and declining benefits.
Medicare recipients could also choose Medicare Advantage, which would be the same as the current Medicare+ Choice offering that puts retirees in HMOs. That program has been a disappointment to recipients and insurers alike. More than half of the HMOs that contracted with Medicare five years ago have quit the program.
Bush seems to be in denial about the popularity of traditional Medicare coverage, which currently serves more than 80 percent of retirees. Even key Republican lawmakers distanced themselves from the president's effort to force retirees out of that program.
The need is clear. Nearly one-fourth of the 35-million retirees on Medicare have no drug coverage and millions more get inadequate help through supplemental policies. The starting point for Medicare reform should be a reasonable prescription-drug benefit for all.
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