The new Medicare law is a mess.
Just weeks ago it seemed that the action over this measure was shifting to the regulatory arena and that the political turmoil of last year had abated, at least until the general election campaign. Suddenly, the "fall" campaign is on, even before spring has begun, and the Medicare law is again at center stage.
Campaign-style ads about the new prescription drug benefit are dueling on TV. HHS is running soft-focus images of happy seniors, while Families USA is using the trusted voice of octogenarian Walter Cronkite to say, "Seniors will not benefit from the Medicare program's bargaining power." Meanwhile, former presidential candidate and current Viagra pitchman Bob Dole has embarked on a speaking tour on behalf of the law, underwritten by Viagra-maker Pfizer, which stands to benefit enormously from the law's lack of spending controls. And likely Democratic presidential nominee John Kerry has been hammering the cost-control issue and the failure to allow seniors to buy cheaper drugs from Canada.
Left in the lurch are hapless seniors, who seem hopelessly confused about what's happening to them. Almost seven in 10 of the elderly (and 77% of the public at large) don't know that the bill had been signed into law in December 2003, a recent Kaiser Family Foundation poll found. The Kaiser poll and another by Harris Interactive came to very different conclusions about public support for the bill, but both found the same confusion.
No wonder. The Bush ad campaign, entitled "Same Medicare. More benefits," tells seniors that "It's the same Medicare you've always counted on, plus more benefits like prescription drug coverage." No mention is made of high out-of-pocket costs, means testing of benefits or the push toward private health plans running the program. A senior in the ad asks, "Will I save on my medicines?" The narrator replies, "You can save with Medicare drug discount cards this June. And save more with new prescription drug coverage in 2006." The fact is, the drugs themselves won't be any less expensive, as even the law's backers concede.
The General Accounting Office has launched an investigation of the ads, which have the same feeling and tone as the new Bush re-election commercials. A total of $22.7 million, including production costs and television, radio and print fees, is being spent on the campaign, HHS told Modern Healthcare.
Meanwhile, the "skimpy benefits" attacked in the Families USA ad are actually quite good for the poorest seniors, who need them most.
As Kaiser Family Foundation President and Chief Executive Officer Drew Altman says, "The lack of understanding of the prescription drug law makes it ripe for political demagoguery on both sides as we enter the election season."
Beyond the commercials, the Medicare law faces rough sailing on Capitol Hill. I think there has been an underestimation of the animosity some Republicans feel toward being sold a bill of goods last year. With the administration now estimating that the cost of the bill is at least $534 billion over 10 years, or $139 billion more than previously estimated, many Republicans have joined with Democrats in looking for ways to cut costs.
(A warning to providers: The added payments hospitals and physicians won last year are in peril in the current climate.)
Earlier predictions that the law would survive intact during this election year must now be considered suspect. Just as things stood in the hectic weeks leading up to final passage of the bill in late November, all bets are off on what will happen next.
What do you think?
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