ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Wednesday, October 23, 1996 TAG: 9610230019
SECTION: EDITORIAL PAGE: A-9 EDITION: METRO
SOURCE: STANLEY B. JONES AND MARION EIN LEWIN
POLITICIANS don't like to talk about it, but most realize that the Medicare program cannot survive in its current form. Expenditures are growing at more than three times the rate of inflation. On its current course, the main part of the program will go bankrupt around the turn of the century.
No matter what happens on Election Day, health-care coverage for the elderly is going to change over the next four years.
One option that has helped control costs for younger people is managed care. Today, about 70 percent of people under age 65 are in some kind of managed-care plan like a health-maintenance organization. The large-scale movement to managed care has been a major factor holding down health-care costs in the past few years.
The vast majority of the elderly continue to get their care through traditional fee-for-service arrangements. But pressures for them to change to managed care are strong and getting stronger. Already, enrollment among Medicare patients in such programs is growing at more than 25 percent a year. For more and more seniors, Medicare is going to mean managed care.
The change may be good for federal coffers, but is it good for the elderly? In too many cases, the answer is no. Many seniors are moving into managed care without enough information to judge which plan is best for them and what each plan covers. They are entering uncharted waters with little direction or guidance.
The problem is not as severe for younger people. Employers often help their workers compare different plans and figure out which would be best. Employer screening of plans, and open-enrollment seasons when employees can change plans, exert important quality controls.
The elderly need the same sort of assistance. Each health-care plan that is approved for marketing to the Medicare population should meet strong standards. It should be offered during an annual open-enrollment season so that beneficiaries can compare it with other options. The plan should guarantee renewal of coverage with no exemptions for people with pre-existing health problems. And it should meet quality standards comparable to those being developed by private organizations.
Just as consumers who buy a new car assume that automakers are meeting basic safety standards, so Medicare beneficiaries should have confidence that any plan they choose meets specified benchmarks. Then they can shop around with confidence for the best alternative.
Surveys show that when seniors have reliable information tailored to their concerns, they are more comfortable with managed-care arrangements. A new private service could help provide such information. For example, Medicare beneficiaries should be able to call a national customer-service center and talk with a representative who has access to computerized data. Toll-free telephone service, on-line communications through the Internet, town meetings and newsletters all could provide additional assistance.
Physicians and patients need to be able to communicate freely and openly. Any health plan that forces its physicians to sign an anti-criticism or "gag" clause should be excluded from the Medicare market. Physicians need to be able to talk with their patients honestly about what kinds of treatments and what kinds of health plans are best for them.
Even as more and more seniors move into managed-care plans, traditional fee-for-service Medicare should be preserved as a viable option. Many elderly have far less experience with managed care than do their younger counterparts. Members of this group who are very old, frail or disabled should not be asked to make decisions that they are incapable of making. A "safe harbor" for Medicare beneficiaries would protect the most vulnerable and retain the trust of beneficiaries.
In the future, all of us are going to have more responsibility for making choices about health care. But if we have good information, we can make good choices. The result will be better health plans and better health care for everyone.
Stanley B. Jones, director of the George Washington University Health Insurance Reform Project and a member of the Institute of Medicine, recently chaired the institute's Committee on Choice and Managed Care. Marion Ein Lewin of the institute was study director for the committee.
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