Building on FDR's legacy for senior citizens
IN 1935, President Franklin D. Roosevelt signed the Social Security Act into law. He believed that it had to be simple, guaranteed, and fair. Designed to liberate senior citizens from the fear of want, Social Security has helped cut the portion of older Americans living in poverty by 84 percent.
In 1965, passage of Medicare and Medicaid marked the second most significant improvement of that century in health security for older Americans. In our own century, as medical research has developed a broad spectrum of lifesaving drugs, Medicare beneficiaries are confronted with a new fear: that necessary drugs are unaffordable.
The new Medicare prescription drug program (Part D) is designed to address this fear. It became effective on New Year's Day, and it marks the most significant change in federal health policy for seniors since 1965. Will it live up to its promise in the way that the initiatives of 1935 and 1965 have helped older Americans secure the basic necessities of life?
As a lifelong Democrat and president of a comprehensive health plan, I am well aware of Medicare Part D's flaws. There have been some well-publicized glitches in the initial implementation of the plan. However, the plan has been in effect for only a few weeks. Medicare Plan D still represents a major advance in coverage for seniors, and many of its problems can be corrected.
The most common complaint about the drug law is its complexity. A December survey of new Tufts Health Plan Medicare members in Massachusetts bears this out, finding that 50 percent understood the new Part D program ''not too well" or ''not well at all." While there is still too much confusion, these results mark an improvement over October, when the Kaiser Family Foundation and Harvard University found that 61 percent understood the plan ''not too well" or ''not well at all." Our survey confirmed exactly what one would expect from any complex change -- that with time, research, and a lot of counseling, seniors are gradually coming to understand and get comfortable with the plan.
If additional time is what some seniors need to make an informed choice, why not extend the period for open enrollment beyond the arbitrary May 15 deadline? (After that, Medicare beneficiaries must pay 1 percent more premium for every month they delay Part D enrollment) Give seniors the full year of 2006, without penalties and restrictions, to make a choice or to switch plans if they are unhappy with their initial selection. Seniors should not be punished for being confused or afraid; they need more assistance in this transition.
In the meantime, the federal Centers for Medicare and Medicaid Services should revise its Part D brochures and its website so that crucial information is readily available and accurate. Furthermore, why can't the Centers for Medicare and Medicaid Services compare for its beneficiaries the cost and benefits of the drug plan options it offers?
The market needs time to sort itself out. Competition affords seniors some flexibility in selecting plans that are tailored to their needs. Sure, having an overwhelming number of options is confusing (Massachusetts seniors can choose from more than 40 coverage plans). But the good news is that over time, as typically occurs in new markets, the best offerings will emerge, reducing confusion in favor of the most popular, valuable plans.
If this doesn't occur, Congress should authorize the Centers for Medicare and Medicaid Services to limit the number of plans available. Just as private employers offer their employees a select few health care options, the Centers for Medicare and Medicaid Services could establish criteria, tied to enrollment, satisfaction and fiscal stability, for remaining in the program. In this way, seniors will feel confident that the coverage they select is secure.
The prevailing wisdom that the prescription drug law is too complex and markets do not work in healthcare threatens to become a self-fulfilling prophecy for many seniors. While 11.6 million people nationwide are now enrolled in Part D, 10.6 million of those enrolled were Medicaid recipients who were automatically switched to Medicare.
Over time, the Centers for Medicare and Medicaid Services should regulate the competition it has created to serve consumers and should guide its beneficiaries toward value, rather than push them into uninformed choice.
If in doing so, Congress is guided by principles of fairness, simplicity, and guaranteed coverage, it can build upon my grandfather's legacy.
James Roosevelt Jr. is president and CEO of Tufts Health Plan in Massachusetts and former associate commissioner of Social Security. 
