D for Debacle - New York Times
The New York Times

May 15, 2006
Op-Ed Columnist

D for Debacle
By
PAUL KRUGMAN

Today is the last day to sign up for Medicare Part D, the prescription drug
benefit. It appears that millions of Americans, confused by the array of
competing
plans or simply unaware of the cutoff date, will miss the deadline. This
will leave them without drug coverage for the rest of the year, and subject
to
financial penalties for the rest of their lives.

President Bush refuses to extend the sign-up period. "Deadlines," he said
last week, "help people understand there's finality, and people need to get
after
it, you know?" His real objection to extending the deadline is probably that
this would be an implicit admission that his administration botched the
program's
start-up. And Mr. Bush never, ever admits mistakes.

But Part D's bad start isn't just another illustration of the
administration's trademark incompetence. It's also an object lesson in what
happens when the
government is run by people who aren't interested in the business of
governing.

Before we get there, let's talk for a moment about the problems older
Americans have encountered over the past few months.

Even Mr. Bush has acknowledged that signing up for the program is a
confusing process. But, he says, "there is plenty of help for you." Yeah,
right.

There's a number that people needing help with Part D can call. But when the
program first went into effect, there were only 300 customer service
representatives
standing by. (Remember, there are 43 million Medicare recipients.)

There are now 7,500 representatives, making it easier to reach someone. But
should you believe what you're told? Maybe not. A survey by the Government
Accountability
Office found that when Medicare recipients asked for help in determining
which plan would cover their medications at the lowest cost, they were given
the
right answer only 41 percent of the time.

Clearly, nobody in the Bush administration took responsibility for making
Part D's start-up work. But then you can say the same thing about the whole
program.

After all, prescription drug coverage didn't have to be bafflingly complex.
Drug coverage could simply have been added to traditional Medicare. If the
government
had done that, everyone currently covered by Medicare would automatically
have been enrolled in the drug benefit.

Adding drug coverage as part of ordinary Medicare would also have saved a
lot of money, both by eliminating the cost of employing private insurance
companies
as middlemen and by allowing the government to negotiate lower drug prices.
This would have made it possible to offer a better benefit at much less cost
to taxpayers.

But while a straightforward addition of drug coverage to Medicare would have
been good policy, it would have been bad politics from the point of view of
conservatives, who want to privatize traditional social insurance programs,
not make them better.

Moreover, administration officials and their allies in Congress had both
political and personal incentives not to do anything that might reduce the
profits
of insurance and drug companies. Both the insurance industry and,
especially, the pharmaceutical industry are major campaign contributors. And
soon after
the drug bill was passed, the congressman and the administration official
most responsible for drafting the legislation both left public service to
become
lobbyists.

So what we got was a drug program set up to serve the administration's
friends and its political agenda, not the alleged beneficiaries. Instead of
providing
drug coverage directly, Part D is a complex system of subsidies to private
insurance companies. The administration's insistence on running the program
through these companies, which provide little if any additional value beyond
what Medicare could easily have provided directly, is what makes the whole
thing so complicated. And that complication, combined with an obvious lack
of interest in making the system work, is what led to the disastrous
start-up.

All of this is, alas, terribly familiar. As John DiIulio, the former head of
Mr. Bush's faith-based initiative, told Esquire, "What you've got is
everything
- and I mean everything - being run by the political arm." Ideology and
cronyism take complete precedence over the business of governing.

And that's why when it comes to actual policy as opposed to politics, the
Bush administration has turned out to have the reverse Midas touch.
Everything
it gets its hands on, from the reconstruction of Iraq to the rescue of New
Orleans, from the drug benefit to the reform of the C.I.A., turns to crud.

Miriam's Comment: You have no idea how confusing the plan is. Each
pharmaceutical company has its own formulary. I chose the AARP plan - only
because I already have their supplemental insurance. The drugs are placed
in various categories. The categories are priced differently with different
co-payments. If one tried to look at a number of companies to figure out
where to get the best deal, it would be totally impossible. Furthermore,
the formulaties can change at any time but you, the recipient, are stuck
with your program for one year. When I signed up, I signed something which
would allow Medicare to withdraw the monthly premium ($24.99) from my social
security check. It was to begin in February, but the premiums haven't been
withdrawn which means that they haven't been paid to the insurance company.
The insurance company is United Health which has promised recipients that
they can use the program even though the premiums have not been paid yet.

Posted by Miriam V