Congress likely to feel pain on Part D

To understand why the elderly distrust the multibillion-dollar congressional largesse that is the new Medicare prescription drug program, it is useful to stop by the Hollin Hall Senior Center in Alexandria, Va.

The converted school is a social hub for retirees in the woodsy suburban hills that roll south from Washington down along the Potomac River. The neighborhood's brick Colonials and fieldstone ramblers are home to middle-class people who have made comfortable livings as federal government workers, or in the military, or for the contractors that serve them.

The retirees of this community were curious and attentive, but not panicked, by the presentation they heard the other day from Howard Houghton Jr. Houghton works for the Fairfax Area Agency on Aging as an insurance counselor. You might say this is his busy season.

For three months he has appeared at more than 50 community events, trying to explain the convoluted maze of the Medicare prescription drug program that begins next month. When he makes his pitch using a Power Point presentation, Houghton usually starts by joking to the seniors that he's going to tell them one lie. The first slide calls the presentation "Medicare Part D Made Easy." "Made easy"- that's the big lie.

At the Hollin Hall center there was no high technology, so Houghton distributed a chart. It was, by the standard of ghastly complication that marks the drug plan, a picture of simplicity. Still, it required flowcharts in four colors, with boxes beneath boxes connected to other boxes.

Each described how different people with different insurance plans and differing drug needs would have to proceed. "Check with your benefits administrator to help you decide whether you should keep your current coverage," it suggested to those with employer, union or military coverage who were following the blue flowchart.

"If you do not enroll, you will be automatically enrolled in January 2006 to make sure your coverage continues," the chart tells those with low incomes who now get coverage through Medicaid.

When he was done, Houghton experienced for the first time one of the other incomprehensible flaws of the Medicare drug program. In this middle-class crowd of about 100 people - some well into their 80s - not a single person wanted to sign up.

"I'd hate to try to figure it out, because there are so many different plans," said Mary Doyle, 79, a federal retiree who already has drug coverage. Many of her friends, Doyle told me in an interview, do need the new benefit. "They have the material, but they don't know what to do about it."

Most elderly people - three-quarters of Medicare beneficiaries, according to the Congressional Budget Office - already have some kind of drug coverage. But millions of others sag under the cost of trying to buy what is often a medicine chestful of prescriptions.

Congress, though, did not create a benefit only for those who need it. That would mean no political favor would be gained from the more vocal middle class. It did not even make it workable for the low-income elderly. Those on Medicaid are to be dropped from that coverage at the end of this month, and they can randomly be assigned to a private drug insurance plan that might not even cover the prescriptions they currently get through Medicaid.

In the Hollin Hall center, where the coffee was hot and the holiday sweets table overflowing - and where no one, it seemed, was much affected by this drug plan at all - a shrug of indifference might have been expected. But irritation bordering on anger was the norm.

There are many who do need the coverage, those at the center told me, and they shouldn't have to navigate such obstacles to get it. "It's as inefficient as hell," says Edwin R. Kellogg, 83, who gets his drug coverage through his former employer, an auto-parts manufacturer. "You know who's going to benefit from this? The insurance companies."

Well, and the drug companies, too. And perhaps a cottage industry of consultants. Thank goodness, the one group that sought the most gain from the Medicare drug benefit - Congress - is likely instead to feel political pain.

Copyright 2005 Newsday Inc.