With open enrollment in Medicare Part D quickly drawing to a close, it is time to seriously ask "What worked? What didn't work? And, how are we going to fix it?"

The new Medicare Drug benefit provides huge complexities and confusing benefits, all at a huge cost to American taxpayers. The Medicare Modernization Act and its drug benefit was called "a Medicare program for the 21st Century" by Sen. Norm Coleman. Instead, according to John Wenberg, MD, PhD, Dartmouth University Medical School, Medicare is accelerating into "a trillion dollar train wreck"* with its bankruptcy estimated to be only a little over ten years away.

The Minnesota Senior Federation, in cooperation with the Medicare Justice Coalition and allied organizations, is launching a "Fix Medicare Rx" Campaign. The Campaign, in part, will call for simplification of the Medicare Part D benefits, controlling drug costs by government negotiations or safe importation, improving low-income benefits and eliminating incentives for employers to reduce their retiree prescription drug benefits.

The Fix Medicare Campaign will also call for a major overhaul of Medicare itself. The current system richly rewards providers and health plans in areas of the country that provide excessive and relatively poor quality health care and punishes beneficiaries and providers in areas of the country which provide higher quality, more cost-effective care. The Medicare Modernization Act has actually increased the disparity in the costs, options and benefits that seniors receive throughout the country.

A Senior Federation examination of health care costs for seniors enrolled in Medicare Advantage plans (that include Medicare prescription drug coverage) in the Twin Cities and Miami reveals just how bad the disparity for consumers in Medicare benefits and costs has become. The comparison is based on a person seeking the most cost-effective Medicare Advantage plan for doctor and hospitalization, prescription drug costs and the health plan premium.

Based on Medicare's own data* the most cost-effective Medicare Advantage plan in Miami would cost a beneficiary $257 for medical costs, including physician health plan premium, doctor and hospital co-pays, and a sample of seven brand and generic drugs costing about $5,000**) annually in 2006. In Ramsey County, the most cost-effective Medicare Advantage plan will cost that senior $2,440 or almost ten times the cost in Miami.***

The following chart compares the cost of one Minnesota HMO (UCare) and a health plan in Miami (Citrus Health Care). This comparison uses the same prescription drug costs as the comparison above but adds a typical number of physician and specialist visits and one hospitalization annually. In this example the cost of the health plan premium, drug coverage (which is far superior in Miami for a monthly cost of 38 cents), doctor visits and one hospitalization to a Ramsey County senior enrolled in UCare Minnesota will be more than $5,500 and in Miami $957.

The Medicare Justice Coalition and the Minnesota Senior Federation are developing a campaign to make sure that providers receive equitable Medicare reimbursements and encourages quality and not excessive health care for consumers. Medicare Part D and Medicare itself are not going to be fixed unless Medicare consumers speak with a united voice to truly modernize Medicare for generations to come. We will discuss campaign details in upcoming regional Federation conventions and in next month's Senior News.