A script for high costs and red tape

WASHINGTON -- Congress seldom does anything simple -- especially in the realm of so-called entitlements, where efforts to balance the needs of a diverse population with the demands of a free-enterprise system always are difficult and generally more expensive than they should be.
From efforts to simplify the tax code to the latest program to provide insurance coverage for skyrocketing prescriptions, while keeping the people and big business happy, the result is usually a nightmare of complexity. This certifies the truth of Will Rogers' assessment that Congress is the largest body of comedians in the world -- every time the lawmakers make a law it's a joke, and every time they make a joke it becomes a law.
The prescription benefit, officially Part D of Medicare, is almost wonderful in its bureaucratic intricacies, a splendid creation of multi-tiered bewilderment that has left huge numbers of those eligible unable to proceed intelligently. Now in its second full month of operation, the price tag, according to critics, is headed for $80 billion a month, a giant windfall for the pharmaceutical industry. By the end of the first decade, in 2016, it is expected to have cost taxpayers a shocking $1 trillion, double the original estimate.
Bad news
But here's the latest bad news: Those seniors at the lowest end of the economic scale who would and should get their drugs for next to nothing under the law's provision that shifted 6 million of them away from Medicaid for prescription purposes aren't cashing in.
Despite $400 million allocated to enroll those with low incomes, only about 1.4 million of the eligible 8 million have signed up, according to press reports. It now is estimated the government will spend about $250 an eligible recipient and still only have enrolled 2 million.
Why? Many of those at the lowest level have no idea how to proceed. They lack English skills, are challenged mentally or physically, change addresses constantly or don't even know that this benefit exists. Some see it as a government handout, and others believe that if they sign up they will lose the benefits they already have. In some cases, they don't want to provide financial information they believe will encroach on their privacy.
The problem has been exacerbated by the fact that, in its original efforts to cover those in the "extra help" category, the government sent out letters to 19 million who might be qualified and ended up dragging in some 2 million who weren't, each of whom cost an estimated $50 in follow-up fees. Close to three-fourths of those caught in the Social Security Administration net were rejected. According to reports, more than half of those rejections came because they had more than $11,500 in assets, not counting a home or car.
The confusion among seniors generally has been well-publicized. Untold numbers have opted not to be covered because they simply found the blizzard of options too difficult to comprehend and would rather keep their own insurance programs as long as their monthly prescription bills don't run too high. To discourage that, the law includes penalties for signing up after a Jan. 1, 2006, deadline.
Critics of the prescription benefit, citing a new study financed by a group of liberal organizations, charged that lobbyists for drug companies, the insurance industry and a broad array of health services were responsible for its rising costs and complexities. The report says that these influential groups poured $96 million into political campaigns, with 71 percent going to Republicans. The study also contends that 13 Bush administration and congressional officials in key positions during the writing and passage of the bill now work for pharmaceutical companies.
Special-interest demands
There is little question that the ever-increasing cost of campaigning has made lawmakers more vulnerable to special-interest demands.
But the real failing may be Congress's historic inability to simplify anything.
Just giving Medicare the power to negotiate the lowest costs rather than permitting the benefit to become a financial sinecure for the drug companies might have saved some confusion and a lot of money. It might have, and then it might not have, given the unreliability of bureaucracies to save money.
One thing seems certain: This program was financially irresponsible in the first place. But it is never going away. If it isn't to end up as one of the bitterest financial pills this nation has ever swallowed, major refinement is absolutely necessary.
Dan K. Thomasson is former editor of the Scripps Howard.