Dear David:

I would have to stridently disagree. If this program was really about taking care of at-risk citizens, it would be easy to navigate, affordably priced, would cover ALL medications that were Medicaid/Medicare reimbursable in 2005, and would have raised revenues to ensure its feasibility (wow, what a concept?!). 

This is most assuredly not the case.  Even those Medicaid recipients being auto-enrolled in plans are not assured of having all of their medications covered.  States are 'stepping up' to make up the difference where the Feds have allowed formularies to eliminate key drugs, but how long is that sustainable? 

What about those low-income Medicaid recipients who up to this point paid nothing for their medications and now will face a $3-$5 co-payment for EACH prescription they have filled?  With 10 drugs a month, that's $30-$50 out of pocket per month that this report fails to mention.

Another point of clarification: you cite the reported 37% average reduction enrollees should experience with the plan.  But upon reviewing the report more closely, you will see that number is skewed by a relatively small number of recipients:  

Low-income beneficiaries receiving additional help with premiums and cost-sharing under the new law, particularly those without Medicaid drug coverage prior to the MMA, are projected to see a significant reduction in out-of-pocket drug spending in 2006. Overall, those who receive low-income subsidies are projected to spend 83% less under the MMA than they would have spent in the absence of the law. However, all other Part D participants (20.3 million in 2006), who are not expected to receive low-income subsidies, are projected to realize a more modest 28% reduction in their average out-of-pocket drug spending.

Another little-emphasized point about the so-called catastrophic coverage:

More than half (55% or 3.8 million) of the 6.9 million Part D participants projected to have spending in the doughnut hole are not expected to receive catastrophic benefits in 2006 because their out-of-pocket drug spending is projected to be less than $3,600.

And as I mentioned about the profligate spending this program (paired with EEOC policy changes) ushers in, see the following corporate welfare:

Our model incorporates CBO’s projection that 2.7 million beneficiaries with employer-sponsored drug coverage will lose it and shift into Part D plans once the new drug benefit takes effect. For purposes of this analysis, we assume this shift will occur in 2006.

It should also be mentioned the numbers used in this November 2004 report were generated by the CBO in July 2004.  After tinkering in congressional committees and subsequent changes in drug costs, these projections may very well inaccurately reflect the actual costs to recipients.

I believe this program has less to do with providing crucial benefits to poor and disabled seniors than it does with driving the federal deficit to a precipice where the cumulative debt load requires slashing of unnecessary (read: social) government programs.

The bottom line is heaven forbid if you are a low-income senior with serious cognitive, vision, or hearing deficits and trying to navigate this shameful mess.

I'm not sure overall. All I can speak for is my father, whose employer-provided retiree coverage was partially replaced by Medicare Part D (the employer now only covers the "donut hole", Medicare covers the rest). He probably will end up with slightly higher costs, but only slightly. However, it was crucial that he picked the right Medicare D plan--there were about 40 options where he lived and many of them would have increased his costs. Choosing a plan is an extremely complex process. I am a consultant who specializes in employee benefits and compensation--so I have extensive knowledge of how benefit plans work. Despite this, it took me several days to pick the appropriate plan for my father. I wonder how the average person chooses. My guess is that lots are making bad choices because the decision is far too complex for someone without specialized knowledge (and lots of time and energy to conduct the necessary research) to make.

The theory is that all the choices will encourage "consumerism"--i.e., encourage people to choose appropriate levels of insurance given their varying medical and financial circumstances. In reality, the complexity of the decision inhibits consumerism because the consumers don't have the necessary information and knowledge to make an informed choice. In addition, the design of these plans tends to weaken their usefulness as risk-management tools that help you predictably limit your costs. Instead they are payment plans for drugs--and you have to guess which drugs you will be taking in the future and have faith that the plan's formulary will continue to cover those drugs if and when you need them.

The Centers for Medicare & Medicaid Services (CMS) have responded to slow voluntary enrollment by dramatically increasing help-line operators from 150 to 4,500 in the program's first week, and achieving voluntary enrollment of over 2 million Americans in the past month.  David Sclar

This assertion seems wrong.

The "help-line operators" aren't there to respond to enrollee questions; they're there to answer questions from pharmacies ("pharmacy support phone lines").

The additional CSRs weren't added because of "slow voluntary enrollment."  They seem to have been added, because CMS and its contractor didn't prepare for dual-eligibility problems.

Sclar's just following the old addage:  When all you've got is lemons, make lemonade.

Comments about the shortcomings of Medicare Part D are duly noted. To answer Jon's question, the CBO data suggest most Medicare Part D beneficiaries will spend less on prescription drugs under the new program. Whether they are net worse off due to limits in coverage, displacement of employer-sponsored coverage, or the burdens and pitfalls of choice pointed out by Purple State is a matter of debate and will be determined with experience.

Ellen is correct to note that the help-line operators added by CMS are Customer Service Representatives (CSRs) who provide support to pharmacists who are struggling to handle dual-eligibles. While this won't boost voluntary enrollment totals, it will help enrollees to receive their medicines with fewer administrative errors and delays.

Ellen is also correct to note that my post looks for a silver lining. Those with an eye on health care reform must balance the establishment of Medicare Part D with concern over its substance.