The KISS Principle

One of my new favorite websites, Wikipedia, describes the KISS principle as:

“A popular maxim often invoked when discussing a design process as a reminder to avoid the unnecessary complexity that can arise during the design process. The traditional expansion of this acronym is “Keep it Simple, Stupid”. This is a vernacular rewording of Ockham’s Razor and has its parallel in Einstein’s dictum “everything should be made as simple as possible, but no simpler.” … Where concerns over the word “stupid” exist, a euphemistic explanation of “Keep It Simple and Straightforward” is sometimes resorted to.”

This principle was demonstrated in the design of the new insurance plans to cover low income uninsured Massachusetts residents as part of the state’s new healthcare reform program. In yesterday’s Boston Globe, State health plans likely to be similar, the article describes:

“The four Medicaid plans that will be offered … starting Oct. 1 are likely to be nearly identical. Jon Kingsdale , executive director of the agency responsible for implementing many provisions of the state’s new healthcare reform law, wants the four companies designing Medicaid plans to focus on simplicity at the expense of innovation. That means the plans, called Medicaid managed-care organizations, will compete mostly on price, their networks of doctors and hospitals, and customer service.”

The four available “plans will be based on an existing MassHealth insurance plan for single adults” and are expected to cover 200,000 of the ~500,000 residents lacking insurance. A few plans have already stated that they expect to introduce more innovative plans next year.

Compare that number to the number of prescription drug plans for Massachusetts seen on the Medicare PDP website:

  • 18 Medicare Prescription Drug Plans
  • 7 Medicare Advantage Prescription Drug Plans
  • 6 Medicare Advantage Special Needs Plans

Some of the biggest criticisms of the Medicare PDP programs are: 1) many seniors are too confused by the breadth of choice and level of plan differences, and 2) general fear of phone scams and misinformation. Many opted not to enroll in lieu of making a poor or uninformed decision.

In May 2006, FamiliesUSA released a report titled “Expectations Shrinking for Medicare Part D Enrollment.” It cites that 24% of low-income seniors eligible for special subsidies are still without drug coverage. The report describes three major likely consequences if low enrollment persists in Medicare Part D:

  1. “Many beneficiaries will still not be getting the prescription drug coverage they need;
  2. Beneficiaries who do not enroll face higher costs later on (because of late penalties to sign up for the benefit as of May 15);
  3. Continued low enrollment in Part D could jeopardize the long-term health of the program especially if a high proportion of those enrolled are those that need coverage the most.”

I applaud Massachusetts for following the KISS principle – especially given their aggressive timetable. I expect that it will contribute to better enrollment than Medicare Part D’s lackluster 24% enrollment.

August 3, 2006

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