Credibility check

It shows how far our government has fallen from the ideal when we have to ask this question: Whom do you believe -- the president of the United States, or a newspaper columnist?

The subject is the new Medicare prescription drug benefit that begins January 1. First, we hear from the president:

"This new benefit is the greatest advance in health care for seniors and Americans with disabilities since the creation of Medicare 40 years ago," Bush said in his weekly radio address.

"With this new prescription drug benefit, Medicare will now help pay for the prescription drugs that can prevent serious illness," he said. "Seniors will get more choices and better treatment, and America will get a Medicare system to fit the needs of the 21st century."

Now, the columnist:

At first, the benefit will look like a normal insurance plan, with a deductible and co-payments.

But if your cumulative drug expenses reach $2,250, a very strange thing will happen: you'll suddenly be on your own. The Medicare benefit won't kick in again unless your costs reach $5,100. This gap in coverage has come to be known as the "doughnut hole." (Did you think I was talking about Krispy Kremes?)

One way to see the bizarre effect of this hole is to notice that if you are a retiree and spend $2,000 on drugs next year, Medicare will cover 66 percent of your expenses. But if you spend $5,000 - which means that you're much more likely to need help paying those expenses - Medicare will cover only 30 percent of your bills.

A study in the July/August issue of Health Affairs points out that this will place many retirees on a financial "roller coaster."

People with high drug costs will have relatively low out-of-pocket expenses for part of the year - say, until next summer. Then, suddenly, they'll enter the doughnut hole, and their personal expenses will soar. And because the same people tend to have high drug costs year after year, the roller-coaster ride will repeat in 2007.

How will people respond when their out-of-pocket costs surge? The Health Affairs article argues, based on experience from H.M.O. plans with caps on drug benefits, that it's likely "some beneficiaries will cut back even essential medications while in the doughnut hole." In other words, this doughnut will make some people sick, and for some people it will be deadly.

The smart thing to do, for those who could afford it, would be to buy supplemental insurance that would cover the doughnut hole. But guess what: the bill that established the drug benefit specifically prohibits you from buying insurance to cover the gap. That's why many retirees who already have prescription drug insurance are being advised not to sign up for the Medicare benefit.

If all of this makes the drug bill sound like a disaster, bear in mind that I've touched on only one of the bill's awful features. There are many others, like the clause that prohibits Medicare from using its clout to negotiate lower drug prices.

Even more disappointing than the question is the answer.

Just a reminder: It'll be 2009, at the soonest, before an elected official has the guts to take on the health insurance industry and give us the universal health care system that this "benefit" pretends to be and that the rest of the industrialized world already enjoys. You'll know who that person is because he -- or more likely she -- won't use terms like "frivolous lawsuits" and "caps on non-economic damages."