Sheer incompetence

The president's signature domestic initiative is discussed in a Washington Post op ed by Harold Meyerson.

It's the president's prescription drug plan (Medicare Part D), though, that is his most mind-boggling failure. As was not the case in Iraq or with Katrina, it hasn't had to overcome the opposition of man or nature. Pharmacists are not resisting the program; seniors are not planting car bombs to impede it (not yet, anyway). But in what must be an unforeseen development, people are trying to get their medications covered under the program. Apparently, this is a contingency for which the administration was not prepared, as it has been singularly unable to get its own program up and running.

Initially, Part D's biggest glitch seemed to be the difficulty that seniors encountered in selecting a plan. But since Part D took effect on Jan. 1, the most acute problem has been the plan's failure to cover the 6.2 million low-income seniors whose medications had been covered by Medicaid. On New Year's Day, the new law shifted these people's coverage to private insurers. And all hell broke loose.

Pharmacists found that the insurers didn't have the seniors' names in their systems, or charged them far in excess of what the new law stipulated -- and what the seniors could afford. In California fully 20 percent of the state's 1.1 million elderly Medicaid recipients had their coverage denied. The state had to step in to pick up the tab for their medications. California has appropriated $150 million for the medications, and estimates that it will be out of pocket more than $900 million by 2008-09. Before Jan. 1 the Bush administration had told California that it would save roughly $120 million a year once Part D was in effect.

California's experience is hardly unique. To date at least 25 states and the District have had to defray the costs to seniors that Part D was supposed to cover. What's truly stunning about this tale is that, while officials may not have known how many non-indigent seniors would sign up of their own accord, they always knew that these 6.2 million seniors would be shifted into the plan on the first day of the year. There were absolutely no surprises, and yet administration officials weren't even remotely prepared.

No such problems attended the creation of Medicare itself in the mid-1960s. Then, a governmental agency simply assumed responsibility for seniors' doctor and hospital visits. But, financially beholden to both the drug and insurance industries, the Bush administration and the Repsublican Congress mandated that millions of Americans have their coverage shifted to these most byzantine of bureaucracies.

This is, remember, the president's signature domestic initiative, just as the Iraq war is his signature foreign initiative.