Fine-tune drug plan.

Byline: The Register-Guard

To their great credit, Medicare officials spared no effort to fix problems with the new Part D prescription drug benefit after a disastrous debut threatened to overwhelm pharmacies and spawn endless lawsuits. At the end of the Part D program's first year, the Centers for Medicare and Medicaid Services, the federal agency that oversees the drug benefit for the elderly and disabled, can point with deserved pride to some significant achievements.

The prescription drug program, which represents the largest expansion of Medicare in its 38-year history, has cost nearly $13 billion less than expected this year. That's almost unheard of for a federal program - not to mention one that deals with volatile health care costs. Almost half of the savings came as a result of robust competition among insurance companies to offer attractive plans.

That competition lowered costs for Medicare beneficiaries: Monthly premiums that were expected to cost $37 when the program began turned out to average about $24. Lower out-of-pocket expenses and strong client support from regional Medicare offices helped produce a remarkable satisfaction rate - almost 80 percent - among beneficiaries, despite the complexity of the program.

So what's not to like? That depends to a great extent on whether one believes the current system, which was designed primarily by insurance and pharmaceutical industry lobbyists, is really the best Congress could do to create a Medicare prescription drug benefit.

Reasonable people may disagree about what constitutes an ideal model for a national health program such as Part D. But no matter how one defines "ideal," the program should put patients first. We don't believe that patients' best interests were the driving force behind the structure of the current program. That's a prescription for disappointment down the road.

As welcome as the news was that competition among insurance plans had saved money, Medicare's own analysis of the numbers indicated that the bulk of the $13 billion savings came from lower than projected enrollment combined with smaller increases in drug prices than had been anticipated. The flip side of that coin is the possibility that in the future, drug prices could increase more than expected.

In addition, premium prices, formularies (lists of covered drugs) and co-pays are certain to be adjusted annually to protect profits, as the law allows. That guarantees the yearly plan review will become a dreaded mandatory headache for Part D participants.

The impressive satisfaction scores for the Part D program's first year will mean something only if they can be sustained. For many seniors, that sense of satisfaction may be short-lived. Some of the most popular plans will charge much higher premiums in 2007.

Because industry lobbyists were able to dictate the details of the program to Congress, the law was written expressly to prohibit Medicare from offering its own prescription drug plan or from negotiating directly with drug companies for discounts on behalf of its 43 million beneficiaries.

It's true that a Congressional Budget Office analysis cast doubt on whether Medicare could negotiate lower drug prices than competing companies in the private sector. No one will ever know if that analysis is accurate unless Democrats follow through on their promise to repeal the prohibition.

Even if Medicare did no better on price than the private sector, its beneficiaries would still come out ahead if Medicare offered its own plan. The annual drudgery of evaluating an armload of different plans - 57 Part D plans are available in Oregon - would be eliminated for seniors seeking simplicity and consistency.

The same Medicare identification card could be used to purchase prescriptions at any pharmacy in the country. People would have the peace of mind that came with a plan backed by an organization that didn't allow the pressures of the bottom line to outweigh the best interests of its beneficiaries.

Democrats should not waver in their pledge to improve the Medicare prescription drug plan by allowing Medicare to negotiate directly with drug companies and offer its own plan. It's not an issue of fixing something that isn't broken. It's about fixing something that's working the way it was intended to work by the lobbyists who designed it.