A day before the first presidential debate, the government's health policy watchdog raised concerns that early mailings to seniors about the new Medicare prescription discount cards (searchchampioned by President Bush were confusing or inadequate.

"We found that these beneficiaries received very little mail from drug card sponsors that would enable them to make an informed choice among cards," the Health and Human Services Department (searchinspector general wrote in the Sept. 29 internal memo obtained by The Associated Press.

The inspector general, the department's independent watchdog, is now conducting a more formal investigation to determine whether there are widespread problems after detecting concerns in an informal survey of 59 seniors, many whom were relatives of agency employees.

HHS spokesman William A. Pierce said the department is giving little credence to the initial survey because it was so small and unscientific, and officials will wait for the results of the broader review.

"If I had presented this in college statistics class, I would have been flunked," Pierce said of the initial survey cited in the memo. "The results, whatever they say, are invalid results because this was a non-random, tiny sample."

The temporary drug discount cards — a frequent topic on the campaign trail and during the three presidential debates — are the first wave of a two-phase plan to provide 41 million Medicare (search) recipients with prescription insurance coverage by 2006.

The plan is touted by Bush repeatedly as a domestic policy success as he makes his case for a second term in the White House. His Democratic rival, Sen. John Kerry, has argued that the president hasn't done enough to help the elderly with the rising costs of health care.

Both the government and insurers approved by the government for the discount program were permitted this spring to mail to seniors information about the cards designed to give a discount on prescription prices until the Medicare coverage benefit kicks in two years from now.

"Contrary to expectations, during the initial startup of the Drug Card program, we found that the 59 selected beneficiaries received little or no mail about the Drug Card Program from sponsors to assist them in making a choice among drug cards," Assistant Inspector General George Grob wrote in the memo to a top Medicare official.

"Most of the beneficiaries reported they did not receive adequate information about the drug card program through the mail and further the information they received was not easily understood," Grob reported.

Grob also raised concerns that many of the sample 59 seniors had received mail from other prescription drug programs that offered "competing services" and "which might cause beneficiaries to question whether to enroll in the Drug Card program at all."

A week after the report, Grob wrote a follow-up memo saying his office wasn't releasing the information publicly because the initial review was designed as a "very quick and early assessment" and that the results couldn't be used to draw conclusions about the rollout of the prescription discount cards.

Mark McClellan, Bush's Medicare chief, wrote a pointed response to the memo last week, arguing it was improper for the independent, nonpartisan inspector general to write about a survey that was "too small to generalize or draw any conclusions."

"What concerns me even more is what I have learned about the nature of who the IG's office recruited to be in the sample - family and friends of OIG office staff," the Medicare chief wrote. "This is a non-representative sample and not a valid way to conduct a reliable and statistically valid analysis."

HHS officials said the timing of Grob's memo also raised concerns. The review was conducted in May and June and department officials were verbally briefed in July but the memo wasn't issued until Sept. 29, the day before Bush and Kerry debated the first time.

McClellan and other HHS officials said the initial survey did not capture the impact of an advertising program and direct mail effort by the government this summer that resulted in a 10,000-a-day enrollment spurt for the cards and which gave seniors a toll-free number to learn more.

"The report also makes no mention of what beneficiaries find when they call this number - a simple, three-step process to sign up for the best card for them," the Medicare chief wrote.

Inspector general's officials said the real benefit of the initial study was to dispel early expectations that seniors were going to be inundated with material about the new program and also to identify "lessons learned" that could be used during the second phase of the Medicare prescription drug plan, documents show.