MANAGED CARE December 2003. ©MediMedia USA
Gail R. Wilensky tried to warn us. Wilensky, who ran Medicare for Bush père in the early 1990s and is now the John M. Olin Senior Fellow at Project HOPE's Center for Health Affairs, was the subject of our Question & Answer department back in July. In that interview, she doubted that Congress would pass Medicare reform, which would include a prescription benefit, before the Fourth of July recess, as many insiders were then predicting would happen.
She did, however, add that "there may be some possibility for compromise that's not obvious at this point." As we were putting that issue to bed, that "possibility for compromise" suddenly appeared when Sen. Edward M. Kennedy, Massachusetts Democrat, endorsed one of the versions of the bill. Should we stop the presses? Should we pull the interview? Wilensky remained adamant that nothing would pass, and we added an "editor's note" at the end of her interview to give us some wiggle room.
Finally, after what? — is it more accurate to say six months or 38 years? — Medicare has a prescription drug benefit. And health plans will play a prominent role in what could arguably be the most significant social policy development since welfare reform or the passage of the Americans with Disabilities law.
A whole lot of money, $400 billion, is going to be thrown at health plans, doctors, drug companies, and hospitals to make the system work. Starting in 2006, some of the ways Medicare beneficiaries will be able to get a prescription drug benefit will be by joining PPOs, HMOs, or some other type of private health plan that also provides the rest of their care.
"It is the beginning ... of privatizing Medicare, make no mistake about it," Kennedy thundered during the debate.
It is also the beginning of a unique opportunity for health plans. The managed care industry, the New Republic noted several years ago, "has compiled the most spectacular record of negative public relations since the nuclear power industry of the 1970s."
Medicare reform is another way of digging out from under the PR muck. Make it work, make it better than it was before and even the industry's harshest critics will have to admit that managed care does good while it does well. Failure is not an option.