Jonathan Cohn on Medicare Part D: The Prescription Drug Benefit

The mess was, he says, predictable--and predicted:

The Plank : THE PREDICTABLE--AND PREDICTED--MEDICARE MESS: So the General Accounting Office report warned that the transition to the new Medicare drug plan might not go too well. Still, that report was issued in December 2005. And by that time, most likely, it was too late to put in place systems and/or programs that could have eased the transition to Medicare Part D. Right?

Well, sure. But it's not like that was the first time warnings had been sounded. For some time, experts have warned that the "dual eligibles"--people who qualify for both Medicare and Medicaid---would have the most trouble with the switch to a new system.... [T]hey are generally very poor and very sick... were automatically going to lose their prescription drug coverage, which Medicaid had provided previously.... [T]he most vulnerable people were going to have to undergo the most dramatic transformation. You didn't have to have fortune-telling powers to see that, without a lot of very intensive planning and hand-holding, this wasn't going to work out too well.... Here's what Jeffrey Crowley... told the Senate Select Committee on Aging in June:

However, given that the most vulnerable segment of the Medicare population is being moved into the Part D prescription drug program first, with not a single day of overlapping drug coverage by Medicaid and Medicare, it strains plausibility to believe that this transition can be perfectly seamless. There is an urgent need for Congress, prior to January 1, 2006, to establish a short-term, onetime transition period so that individuals can continue to rely on Medicaid if they are unable to access appropriate drug coverage through Medicare....

Dr. Carl Clark, CEO of the Mental Health Center of Denver, made the same essential point in March of 2005:

[W]e're concerned about the required transition of dual eligibles to the new part D, drug benefit and here's why.... [A]lmost 40 percent of the 6.5 million dual eligibles have cognitive impairments and mental illnesses. Dual eligibles are twice as likely as others to have Alzheimer's disease... lack the capacity to manage the automatic enrollment process....

And then there was this warning, issued all the way back in January of 2005, via an issue paper by the Henry J. Kaiser Family Foundation:

The transition of prescription drug coverage for dual eligibles from Medicaid to Medicare represents a major shift in care for a particularly vulnerable population... poorer health status and heavier reliance on prescription drugs... consequences of gaps in coverage and missed medications can be severe for this group... maintaining Medicaid as a backup source of coverage on a temporary basis or devising special outreach and education efforts...

The administration didn't completely ignore such advice. There was some outreach, some of it apparently well conceived (like enlisting local groups with multilingual speakers to reach immigrant communities). Still, it obviously wasn't enough.... Can't imagine government having such foresight or being so pro-active? Believe it or not, once upon a time it was ...

UPDATE: Senator Jay Rockefeller, Democrat of West Virginia, has just introduced a bill to help senior citizens struggling with the new Medicare drug benefit. Talk about grandstanding! Where was he last year, when there was time to fix the problem before it happened? Why didn't he propose something then? Oh, wait, he did ...