Thursday, January 19, 2006

Bitter pill, bitterer donuts

With heads still shaking from the mismanagement of Katrina relief, the pork-barreling in the highway bill and the defense appropriations bill, and the ever-growing web of Abramoff entanglements, it’s easy to forget about what might be this year’s biggest domestic debacle.

Anyone who tried to go to a pharmacy the first week of this year no doubt saw at least some level of the Medicare “Part D” disaster. I witnessed a half-dozen furious seniors venting emotions that ranged from tearful despair to homicidal rage when they discovered that drugs they once were able to affordably access would now cost them unimaginable amounts. Pharmacists and their assistants frantically tried to call government help lines only to encounter busy signals or multi-hour waits on hold. It reminded me of the scene in A Clockwork Orange where the aged bums beat the crap out of Malcolm McDowell: “It was old age having a go at youth.”

Some pharmacists have advanced drugs or paid out of pocket. Some states have stepped in to bridge the horrendous gaps in drug coverage, saying that they would seek reimbursement from the federal government. But the feds, saddled themselves with a marked overrun in this program’s costs, have recently said in no uncertain terms that reimbursements would not be forthcoming (once again sticking it to the state governments—a persistent pattern under Bush). The private insurance companies assigned to handle this brave new world have been, for the most part, unresponsive to the problems of their new customers.

Bush and his mouthpieces have dismissed the suffering as the usual problems associated with starting up a new program: “growing pains,” “a few kinks,” “glitches,” “bugs.” Comparisons have been made to the start of Medicare itself, but Kevin Drum, quoting Jon Cohn, points out that may not be the best argument for the administration.

So what happened on the day that this complex program [Medicare] was implemented? Thousands of senior citizens simply went to the hospital and got the health care they needed. "There were no crises that I remember," says Yale University political scientist Theodore Marmor, who worked in the office overseeing Medicare implementation and went on to write The Politics of Medicare, the program's definitive history. Newspaper accounts from the '60s back him up. Under the headline "medicare takes over easily," a Post writer described the program's first day as "a smooth transition, undramatic as a bed change." Three weeks later, the Times affirmed that "medicare's start has been smooth."

In fact, just about every comparison you can make between a standing federal program and a Bush-era reform finds that things have been made worse. One has to ask, “Why give yourself the headache?” With the threat of international terrorism and the budgetary and emotional sinkhole commonly called the Iraq war, why take on the baggage of a Medicare overhaul?

Perhaps it is easy because this government is not taking it on at all. Mirroring its approach to just about every issue, the Bush administration has offloaded responsibility for both the execution and the repercussions. The buck stops anywhere but here. Privatization, be it in Medicare or the military, allows Bush & co. to stop thinking about it while heaping huge financial rewards on friends, cronies, and contributors to Republican campaigns.

And, in most of these cases, the ills of privatization are chronic. Mismanagement, corruption, and featherbedding plague private reconstruction projects and security initiatives in Iraq. . . and in the US Gulf States, as well. In the case of Medicare “reform,” as truly awful as the first few weeks have been, most seem to agree that the worst is yet to come. The “donut hole,” as it is called—a freakish proviso in the Medicare drug scheme that stops coverage between $2,251 and $5,100—should soon become what Michael Hiltzik calls “donut hell” as seniors’ drug costs mount.

The tiny silver-lining—and I am loathe to express any optimism that springs from the suffering of so many—the possible dividend that might be reaped by all of us as a result of the windfall profits reaped by all of them, is that the donut hole might start hitting Medicare-eligible Americans in the months just before the November elections.

If precedent holds, older Americans will vote in larger percentages than most. It is incumbent upon the Democrats running this fall to remind these voters that it was Bush, Hastert, DeLay, and most other Republicans that worked overtime to saddle them with this donut hole; maybe then, some Republicans will get their just desserts.


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