"Why is CBS writing me and what is Medco?"

My dear 90 year old grandmother, who spent almost all of her working years assembling light switches for Westinghouse, retired a good many years ago. At least those were different times and her union had been able to negotiate decent pension benefits, including prescription drug coverage for retirees. So, in many ways, she has been one of the fortunate senior citizens who hasn't had to sign up for Medicare part D. However, she is very confused by the ever-changing nature of her current medical coverage. I attempt to capture the substance and flavor of the conversation I had with her over Christmas.

Grandma Kay [GR]: "Why is CBS writing me and what is Medco?"
Hapless Apologist for the American Health Care System [HA]: "What?"
GR: "I got this in the mail." (Hands over an envelope)
HA: (reading) "Hmm. CBS seems to be switching your prescription drug coverage from Express Scripts to Medco and you'll have to transfer your prescriptions to them."
GR: "CBS? What does CBS have to do with it?"
HA: "Well, gee, I don't know. CBS must have bought out Westinghouse or something like that."
CR: "I thought somebody called "Whyacon" wrote me about my benefits last year?"
HA: "That was Viacom, now it's CBS, just don't ask me why it keeps changing."
GR: "Do I have to change?"
HA: "Well, if you want to keep getting benefits, I guess you do. Let's see, we'll have to make sure that you give Walgreen's the new information, that is if Walgreen's is a participating pharmacy with Medco like it was with Express Scripts, and have to get new info to all your doctors so that they don't send in new prescriptions or refills to Express Scripts anymore and we'll need to--"
GR: "That sounds like too much trouble. I've been getting my drugs from Scripts for years now since I retired. Can't I just keep doing what I'm doing?"
HA: "I guess you could keep getting drugs from Express Scripts but then you'd have to pay full price, since CBS wouldn't be subsidizing them--"
GR: "What does CBS have to do with it again?"
HA: "Your Westinghouse pension is with CBS now and they want you to use Medco--"
GR: "Is this something the government is doing?"
HA: "Well, no, CBS has decided they want to change to Medco. I mean, in a sense the government is involved since they haven't created a single payer system for prescription drugs--"
GR: "Why is CBS making me change?"
HA: "I don't know. I guess they think Medco will save them more money than Express Scripts?"
GR: "Will it save me any money?"
HA: "Well, no, but at least it is a pretty good benefit. Your drug costs are capped at $2000/year which is better than your sister Jean who has no cap on her Medicare drug coverage and, since it's through your pension, you pay no premium--"
GR: "But I do pay a premium. I'm paying $125 a month for the supplemental."
HA: "That premium's not for prescription coverage, that's for Medigap coverage."
GR: "What?"
HA: "Well, there's Medicare Part A for hospitalization, and then there's Medicare Part B for doctors visits, but not all of that is covered by Medicare, so that's why you're paying the Medigap premium and then they did add Medicare Part D for prescription coverage, but your pension coverage is better than the Part D so we decided you didn't need to sign up for that. Remember?"
GR: "Why is it so confusing? And why does Dom [her sister Jean's husband and a WWII veteran] get to go to the VA and get all his doctors and drugs from one place?"
HA: "Because Jean and Dom keep voting for Republicans because the health care industry paid for those Harry and Louise ads that scared everyone into thinking that the government was going to create a complex and inefficient health insurance system!"

I think that the moment I lost it was when I said that the premium she was paying was for Medigap coverage not for prescription drug coverage, as though these were rational categories that any 90 year old retired factory worker who never even got to go to high school ought to be able to keep straight. It's not like my grandmother is stupid or has dementia. She's quite capable and living on her own, handling her bills and everything, but the complexity of her health insurance situation is so many orders of magnitude beyond anything else with which she has to deal. Meanwhile, her brother-in-law Dom is getting quality, cheaper health care from the VA. Why can't it be as simple for all senior citizens and for the rest of us, for that matter?

The 2007 House Democratic leadership is focusing on one small change that would make it simpler and cheaper for senior citizens who do not have private drug benefits by allowing seniors to choose a prescription drug plan administered directly by Medicare, but even if this passes I still won't be able to answer my grandmother's question about why health insurance in the United States is so confusing when virtually every other major industrial country offers universal health coverage.