Tuesday, January 24, 2006

MANY OF THE problems that have plagued the new Medicare drug benefit since its launch at the beginning of this year were not only predictable but predicted. Soon after open enrollment began last year, Web sites began to jam, incorrect information was dispensed and seniors started telling pollsters they didn't understand the benefit very well, if at all. When the plan began actually dispensing drugs on Jan. 1, a lot of those problems worsened.

The difficulties that seniors, insurers and pharmacies have encountered fall roughly into two categories. Some are the kinds of problems that would be expected with the launch of any program as big as this one, the largest expansion of government benefits in decades. That pharmacists aren't used to the system yet and make mistakes isn't surprising. Neither is the fact that it takes several days for plans to become active once a senior has chosen one.

But some of the problems are more closely related to the nature of the benefit as Congress designed it. The huge number of plans, and the fact that they vary from state to state, has meant enormous problems with data transmission among seniors, pharmacies, the government and insurers, and much garbled or incomplete information. Not all of the insurance companies that made plans available have proved quite up to the task. Many did not employ nearly enough people to answer telephone queries, meaning it has sometimes taken far longer than it should have to get questions answered. Involving the private sector in a benefit this big may prove beneficial in the long run, especially if, as Health and Human Services Secretary Mike Leavitt predicts, many plans prove uncompetitive or strive to become simpler over time. But in the short term, the government should have demanded more support and more simplicity, and generally placed a higher bar for entry for the companies seeking to participate in the program.

Mr. Leavitt is promising to rectify some of the problems, in part by deploying what he calls an "army of technicians" to solve the data issues, but also by requiring a minimal level of service from the insurance companies -- and by launching investigations of those companies that appear not to be meeting their contractual obligations. He isn't proposing any legislative changes at the moment, but Congress should be watching carefully and looking for ways to alter and update regulation of the program so it produces simpler plans and attracts better-prepared insurers. This vast experiment in private provision of a state benefit is far from over. It could succeed -- or at least become cheaper and more efficient with time. But it hasn't gotten off to a good start, and the politicians who legislated it should try hard to understand why.