Three words, one circus; Medicare open enrollment. On the surface, the goal seems simple enough: provide health care services for senior citizens and those who are permanently disabled. Subcutaneous exploration reveals a dark labyrinth of confusion, full of dubious pitfalls and misinformation, with little explanation for those who take time to seek it. Every year most Americans go shopping for health insurance, they call it open enrollment, and for working people who receive benefits through their employer based plans, a lot of the shopping has already been done. Still, many people find it very confusing and difficult to think through the limited amount of decision making they are left to make. Seniors have it worse; they don’t have a human resource department with trained people to make decisions; they have to do it all themselves. Making it worse, insurance companies that provide medicare benefits have to market their products to individuals like any other product, sell sell sell. Now, if seniors were well informed and companies always acted with integrity the environment might not be as threatening, but the current system has created exactly the opposite situation, and plenty of companies try to take advantage of trusting, ill informed Medicare enrollees.
Over time, many managed care organizations have carved out specific benefits to other organizations. For instance, most people have a vision plan, a dental plan, etc. Medicare is no different. The one benefit that has been carved out but is just a little different in nature than the others is the pharmacy benefit. The dental plan wants you to have great teeth, the vision plan wants your eyes to be fine. It’s in their best interest for you to be healthy so that you don’t require costly services; that’s how they make money. The pharmacy benefit is different, it has the least vested interest in your future health. It doesn’t care how you die, whether you have to be in long term care, or have coronary bypass surgery, the difference in cost to it is negligible. The pharmacy benefit company makes money by not providing people costly drugs, or by making the cost sharing portion tilted favorably in their direction. This creates an ethical predicament that doesn’t normally get ‘carved out’ in discussions about Medicare Part D open enrollment.
Again, while many working people have a limited amount of choice and human resource departments to ensure the benefits they offer are conducive to keeping workers productive and off disability, seniors must figure it all out for themselves. Misinformation and confusion can lead to bad decisions about which plans to enroll in and consequently can effect a persons access to needed medicines for the entire following year. The effects of these bad decisions compound at the macro level and effect the delivery system at large. By denying access to more expensive drugs, and the benefits those agents provide, patients improve less and require more care, thus placing more demand on an already stressed system.
Although I’m unaware of the potential amount of dollars that might be saved if more responsibility for outcomes were shifted to pharmacy benefit providers in Medicare, it’s hard to imagine that making those who provide access to drugs in order to achieve outcomes they don’t really care about, just a little bit more responsible for the outcomes, would lead to worse outcomes.
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The idea behind cost sharing in Medicare part D, such as the deductible, high copays, and the rediculous “doughnut hole” in coverage is to make seniors more aware of spending and trim unnecessary expenditures. The whole idea is absurd, because all it does is make seniors stop taking necessary medications when they can no longer afford them. Plus, especially when it comes to a senior population, they shouldn't have the burden of deciding what medications are expendable in the first place. The burden should be placed on physicians to know what medications should be prescribed and which can be discontinued, and when generics are appropriate and when more expensive name brands are worthwhile. If stricter controls and benefits were given to physicians for cost-effective prescriptions with effective health outcomes, the system would be all the better for it.
Drew,
I tend to agree with the latter half of your comment, but I'm a little perplexed by the initial discussion. Do you advocate that seniors be given open/cost free access to all health services with no cost-sharing component? Studies have shown that seniors don't typically stop taking necessary medications under the current system, despite the cost being quite burdensome to them.
-M
Mikey,
I don't advocate for eliminating any cost sharing component, merely the severity of the cost sharing with relation to Medicare Part D. It is a convoluted system that usually requires looking into Medigap policies, etc., and I think there is much room for improvement. Perhaps studies have shown that the majority of seniors do not stop taking their meds despite the high cost, although i had read that it is a potential and not uncommon outcome. Regardless, it is quite burdensome.
Indeed what you say is true. There are many problems with Medicare Part D; however, pre-part d seniors had to pay for the total cost of their drugs. Burdensome is a very accurate description.