Has anybody out there figured out what to do about the new Medicare prescription-drug "benefit"?

As with so many other vicissitudes in the Age of Bush, the New York Times's Paul Krugman has put it best: In matters from disaster preparedness and relief to a prescription-drug benefit, it's hard to expect much of a job from a government that doesn't believe in the role of government.

Of course the ignorance, ideological savagery, criminality and general incompetence of this admistration extend way beyond this simple rule of thumb. For example, it's clear that all the power players in this administration, notably the vice president and the secretary of defense, believe fervently in whatever governmental function they fantasize they have been fulfilling in Iraq, and yet it's hard to see how the affair could have been managed worse, except from the standpoint of the cronies like Halliburton that have been cleaning up on the debacle.

(I notice that I seem to use the word debacle a lot in writing about the Bush cabal. This gives me pause, but I really don't think it has been excessive. How else would you describe a track record like this?)

However, this doesn't diminish the importance of what Krugman's rule of thumb is telling us. While these people are clearly capable of screwing up in many other ways, what chance is there of their ever getting anything right which doesn't fall within their excruciatingly narrow view of the role of government?

Americans seem finally to have gotten the idea with regard to the administration's Social Security "reforms." At least for the time being, that package has rung up a resounding "no sale."

However, thanks to the Rove gang's full-court press on Congress at a time when Americans were still paying hardly any attention, we're stuck for the foreseeable future with the administration's truly atrocious Medicare prescription-drug benefit. You didn't have to probe very deep into the thing to appreciate that the only intended beneficiaries are the insurance and pharmaceutical companies.

I've been tracking this with the inevitable mix of confusion and dread, since I have to figure out how to advise my 86-year-old mother to proceed. Every month or so I stumble across another newspaper or magazine article that only confirms my confusion and enhances my dread. I don't know what to do, and at this point, as long as I can be assured that her expectably large number of prescriptions won't cost us more if we do nothing, then nothing is what we may do.

Of course, even I in my economic semiliteracy understand enough about how actual insurance works--i.e., by spreading the risk, so that people who don't collect are covering the costs of people who do--to know that if it were truly possible for every consumer of this "benefit" to find a plan that benefits him/her financially, then the plan would be a fiscal catastrophe.

And it may yet be, especially when you reckon in all the money intended to pour into the coffers of the insurance companies (somebody, after all, has to pay for all that advertising to lure us into . . . uh . . . into whatever the heck it is they're selling), not to mention keeping Big Pharma's cash registers ringing merrily. In that case what we would have in effect is a direct prescription-drug subsidy to senior citizens, which might in fact have been an excellent idea.

I don't think that's what the Bush cabal had in mind, though, or what's going to happen--though I also don't doubt that the program will be very expensive. After all, from the cabal's standpoint out-of-control costs in this program have the additional benefit of making it easier to take aim at and ultimately destroy Medicare proper and Social Security itself.

I must have missed the most recent New York Times article on the prescription-drug benefit, on Friday (maybe because I was attempting to deal long-distance with a more immediate health crisis), but it drew this interesting letter printed in today's paper:

To the Editor:

Re. "Over a Million on Medicare Sign Up for New Drug Plan" (news article, Dec. 23):

The swell of people signing up for the new Medicare drug plans should not be taken as a sign that all is well. While the program may save people some money, the detailed rules may ultimately prove unworkable. For instance, the plan a person chooses can change the drugs it covers on 60 days' notice, but the person is locked into the plan for a year.

Unanswered questions loom, such as what will be the impact of enrollment on continued employer health coverage; who has authority to enroll a person with diminished capacity; and how plan exceptions will be processed.

Taxpayers are paying for a powerful marketing campaign of television, print and bus ads to encourage people to sign up, with little money allocated to helping people, one on one, understand the complicated terms of the plans. We are left wondering why this "benefit" is so hard on its beneficiaries.

--Amy T. Paul, Executive Director, Friends and Relatives of Institutionalized Aged