For Medicare, the 21st century will start ahead of time -- to be precise, in November 1998. That's when a range of new privately managed Medicare plans will be unveiled. This program is going to be known as Medicare Choice.
Everyone, young and old, should be paying close attention. You're going to see a blueprint for what Medicare may become.
There's one little problem. Seniors need to be told, in great detail, what their new choices are going to be. Without unbiased information, this new "market" in Medicare plans won't work well. Yet Congress is on the verge of slashing the funds that were promised to help seniors compare these plans, so they can choose the one that will serve them best.
Under the balanced-budget law, the public-information campaign for Medicare Choice will be run by the Health Care Financing Administration, which manages Medicare and Medicaid.
The cost is supposed to be borne by all the privately managed Medicare plans (principally HMOs). The law set their first-year contribution at up to $200 million -- a small fraction of what the HMOs are paid by Medicare each year.
But the HMOs are telling their allies in Congress that they won't pay anywhere near that price.
At first blush, the budget does sound high. But the job is huge. Just one year from now, some 38 million Medicare beneficiaries are supposed to receive a booklet comparing all the competing medical plans available in their area.
The booklet will cover traditional Medicare, existing HMOs and any new types of plans that have started up. Based on what you learn, you'll have to decide which one you want.
So getting good information will be critical. Here's what the law says the Health Care Financing Administration booklet has to do:
1 -- Compare each Medicare plan on specified points, such as medical benefits, out-of-pocket costs, emergency care and doctor choice. Some of the new plans are going to be more expensive than others.
2 -- Disclose comparative quality data for every plan. This includes surveys of patient satisfaction, the rate at which patients quit the plan and data on the percentage of patients who receive preventive care. In the future, you're also supposed to get data on how sick patients fare.
3 -- Maintain toll-free telephone lines and an Internet site where people can get more information about the plans. A lot of specialists are going to have to be trained.
The Health Care Financing Administration has been worried that even $200 million won't get the job done in time. Nevertheless, the HMOs' allies in Congress seem ready to chop the consumer-information budget to something in the $95 million range.
"At that level, will there be enough people to handle the phone lines?" wonders a congressional source who's close to the legislation. "Will the booklets be printed on something that looks like recycled toilet paper? Will people say 'yuck' and throw the information away?"
The HMOs aren't stopping with cutting the outreach program's total size. They're also angling to pay almost none of it themselves.
Under the law, each Medicare Choice plan (most of them HMOs) is supposed to pay a pro rata share. Congress deemed this fair, because they're the ones the booklets help. Their plan information will be mailed to every Medicare household.
But speaking for the trade group, the American Association of Health Plans in Washington, D.C., senior vice president Rick Smith says the plans should pay around 15 percent of the cost, because they cover 15 percent of the total Medicare population. Apparently taxpayers should cover the rest.
Ironically, Medicare HMOs got a windfall from taxpayers this year -- thanks to another change in the law.
Medicare HMOs have always been paid in advance for the patients on their rolls. Adjustments for overpayments were made the following year.
But Congress is letting the HMOs keep last year's overpayments, which, together with other accounting changes, came to some $666 million. And even with all this extra money, they don't want to meet their obligations for Medicare Choice.
The Health Care Financing Administration will do its best with whatever money it gets. But it's not a large agency for the work it does. If Congress lets the HMOs wiggle off the hook, the Health Care Financing agency will have to take the cost of the booklets out of some other medical service or plan.
If I were cynical, I'd say that HMOs and their allies see underfunding as win/win/win. The established HMOs can keep you from getting good info about other plans. Congress can say it saved businesses some money. And if something goes wrong, the Health Care Financing Administration (read: "the government") will get blamed.