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Bush's prescription drug program stands as monumental mess


The hideous complexity of President Bush's prescription drug program has reduced elderly Americans - and their children - to tears of bewildered frustration. The multiple options when you sign up, each with its own multiple ceilings and copayments; the second round of red tape when you want to acquire some pills; the ludicrously complex and arbitrary standards of eligibility, which play a cruel and pointless game of hide-and-seek as they lurch up and down the graph paper like drunks.

Mr. Bush's only major domestic accomplishment in six years as president has not achieved its intended purpose of cementing the affection of senior citizens for the Republican Party. It is one thing to put aside your principles and spend hundreds of billions of taxpayer dollars on the largest expansion of the welfare state since the Great Society if it is going to help you to win elections (so you can pursue your dream of smaller government). It is another to sell your soul and not get anything for it. No one looks more foolish than a failed cynic.

But look on the bright side, say the Bushies. The wretched thing does seem to be restraining drug prices, and costing the government less than it was supposed to. The current cost estimate is only $678 billion over 10 years. That's down 8 percent from the previous estimate of $737 billion.

Cool. But when the prescription drug benefit was enacted in 2003, it was supposed to cost $400 billion over 10 years.

Who believes any of these numbers? I will bet anyone a month's supply of Lipitor, collectible in 2016, that the 10-year bill will be more than $678 billion.

What's shocking about this, more than the numbers, is that Mr. Bush's drug benefit comes without even a theory about how it will be paid for.

A transparently phony theory at least pays tribute to the hypothesis that money doesn't grow on trees. Not even to bother coming up with a phony theory is an arrogant insult to democracy. It raises "because I said so" to a governing philosophy.

Mr. Bush's other big attempt at a domestic initiative - Social Security privatization - came with a theory: Investing in stocks pays better than government bonds. So you can close the looming gap between Social Security revenues and benefits by letting folks invest for themselves at least part of what the government is now investing for them in those dismal bonds. The theory had a comically obvious flaw: How can society as a whole divert money from government bonds to private stocks as long as the government is still spending and borrowing as much as ever? But at least it was a theory.

The drug program has no theory. It addresses none of the conundrums of the pharmaceutical age. Pills are increasingly central to medical care, and many more miracles await. But pills are also a characteristic post-industrial product, like software or movies: They can cost billions to develop but can be mass-distributed for practically nothing.

Without a theory, the prescription drug benefit is a straightforward matter of writing checks. Nothing wrong with that, in my book. But even if this subsidy to senior citizens survives its rocky premiere, it is doomed.

In 1988, a Republican president and Congress enacted a bill to address the other missing piece in Medicare: insurance against the cost of long-term or catastrophic illness. But seniors, initially delighted, recoiled in horror when they discovered that they were expected to pay premiums to cover the cost of this insurance. The benefit program was repealed the next year. It didn't occur to them back then to pass the benefit and ignore the cost.

That's progress.

Michael Kinsley is a social commentator who lives in Seattle. His e-mail is mike.kinsley@hotmail.com.

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