Elder Law Prof Blog

Not elder law: New element discovered!!

The recent hurricanes and skyrocketing oil and gasoline prices helped to prove the existence of a new element. In early October 2005, a major research institution announced the discovery of the heaviest element yet known to science. The new element has been named "Governmentium."

Governmentium (Gv) has one neutron, 25 assistant neutrons, 88 deputy neutrons, and 198 assistant deputy neutrons, giving it an atomic mass of 312. These 312 particles are held together by forces called 'morons' which are surrounded by vast quantities of lepton-like particles called 'peons.' Since Gv has no electrons, it is inert. However, it can be detected, because it impedes every reaction with which it comes into contact. A minute amount of Gv causes one reaction to take over four days to complete, when it would normally take less than a second!

Gv has a normal half-life of 4 years; it does not decay; but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places. In fact, Governmentium's mass will actually increase over time, since each reorganization will cause more morons to become neutrons, forming 'isodopes.' This characteristic of moron promotion leads most scientists to believe that Gv is formed whenever morons reach a certain quantity in concentration. This hypothetical quantity is referred to as 'Critical Morass.'

When catalyzed with money, Gv becomes "Administratium' (Am) - an element which radiates just as much energy as Gv, since it has half as many peons but twice as many morons.

Special thanks to J.D. Hanson.

Ed:  Tomorrow's vote on the 775-page budget bill that undercuts the safety net and gives money to HMOs and those in the upper 2% of the wealth hierarchy should provide ample external proof of the existence of this new element.

Mea culpa on President Bush explains Medicare Part D

A few days ago I posted President Bush's explanation of Medicare Part D.  I goofed.  No it's not an urban legend.  But he wasn't explaining Part D, rather, his remarks concerned his plan for privatizing Social Security.   That certainly makes me feel better!

Not elder law: National Veterans History Project

The Library of Congress is compiling the National Veterans History Project. The immediate goal is to get stories of the WWII vets.  Stories from people on the home front - Rosie the Riviter, Red Cross bandage wrappers - are also welcome.

Oral histories from veterans from subsequent armed conflicts can also be compiled. Amateur historians can get information from the LOC web site about how to conduct and preserve the interview.  The 18-page "Field Kit" of instructions is at http://www.loc.gov/vets/Field_Kit4.pdf.

CCELS Call for Papers

The Canadian Centre for Elder Law Studies invites submissions for papers and workshops to be presented at its 2nd Annual Canadian Conference on Elder Law, to be held end of October, early November, Fall 2006, specific dates to be announced shortly.

While this invitation embraces a broad variety of socio-legal topics, the theme of this year’s Conference is “Legal and Societal Challenges of Aging: A View for Positive Change.” Selected papers will be published in the 2007 issue of the Canadian Journal of Elder Law. We also welcome abstracts, on a variety of topics affecting older adults, for workshops that do not require a paper presentation. Click here for Call for Papers Registration Form and full details.

For more info, visit the CCELS website.

Ireland: More needs to be spent on elder care

From Ireland On Line:

The State needs to spend an extra €500m each year on community care for older people, it was claimed today.

The National Economic and Social Forum (NESF) said Irish spending on the elderly is the lowest in Europe, at almost €6,500 per person compared to €19,500 in Denmark.

In its report on care for older people, it recommended that spending be increased by €500m annually over a five-year period to bring Ireland into line with Organisation for Economic Co-operation and Development (OECD) levels.

“The robust economic outlook provides the opportunity and the resources for investment in developing community-based care responses as recommended in this report,” it said.

The report’s key objective is to help older people fulfil their wish of living independently in their own homes and communities as long as possible. It recommended that the extra funding be used to provide increased home and community care, which includes meals on wheels, chiropody, cleaning, transport, community centres and sheltered housing.

It said the Government had to get rid of "perverse investment incentives" which were acting as a barrier to community care.

“Considerable resources have been invested in nursing home care responses, some of which was unnecessary, not wanted and inappropriate.”

The report said financial supports should be re-balanced away from nursing and hospital care towards community and residential settings.

The report cited the example of the Choice programme in Sligo, Leitrim and Donegal, which has allowed older people to stay in their homes by accessing individualised and flexible services.

But it said that services for older people were patchy around the country and recommended that entitlements should be clarified and needs assessments introduced.

The report said that getting rid of ageism had to be a priority. This includes attitudes such as older people are ‘all the same’; older people are frail, disabled, stuck in their ways, even confused; and older people are lonely and isolated.

Read more.

Feb. 1 vote on budget will determine the fate of millions of children and elderly

Kaiser Network has summarized the nation's newspaper reporting on tomorrow's vote on the budget bill.  The time is now to contact your state's representatives in the House and tell them that protecting the nation's most vulnerable seniors and children should be a budget and policy priority.
   
Spending Cut Bill Would Lead to Many Beneficiaries Paying More for Medicaid, Some Ending Enrollment, Foregoing Care, CBO Report Says

About 45,000 Medicaid beneficiaries would lose coverage in 2010 because of premiums included in the fiscal year 2006 budget reconciliation bill (S 1932), and 65,000 would lose coverage in 2015, according to a new report from the Congressional Budget Office, the New York Times reports. The bill would save $38.8 billion over five years and $99.3 billion over 10 years. Medicaid and Medicare spending reductions would account for 50% of the savings, with 27% from Medicaid and 23% from Medicare over 10 years (Pear, New York Times, 1/30). The House on Dec. 19, 2005, voted 212-206 to approve the bill, but procedural moves in the Senate require the House to vote on the bill a second time before the legislation can move to President Bush for consideration. The Senate on Dec. 21, 2005, voted 51-50 to approve the legislation (Kaiser Daily Health Policy Report, 1/12). The second House vote is expected on Wednesday. "In response to the new premiums, some beneficiaries would not apply for Medicaid, would leave the program or would become ineligible due to nonpayment," the CBO report states. Children would account for 60% of the Medicaid beneficiaries who would lose coverage, according to the report. The report also estimates that 13 million Medicaid beneficiaries would have new or higher copayments for services such as physician visits and hospital care. In addition, 13 million Medicaid beneficiaries would pay more for prescription drugs by 2010, and 20 million would pay more by 2015, the report states. According to the report, "About 80% of the savings from higher cost-sharing would be due to decreased use of services." The report estimates that 1.3 million Medicaid beneficiaries would have to pay premiums and that 1.6 million would lose benefits, most likely for dental, vision and mental health services. In addition, the report estimates that 15% of Medicaid long-term care beneficiaries would have their coverage delayed because of additional restrictions on asset transfers.

Defeat of Bill 'Unlikely'
The CBO report "gives Democrats new ammunition to attack" the budget reconciliation bill, but they "appear unlikely to defeat it," the Times reports (New York Times, 1/30). However, opponents have "stepped up their attacks on legislation they contend is written to protect insurance companies, drug manufacturers and other entrenched corporate interests," CQ Today reports (Dennis, CQ Today, 1/27). Rep. Rob Simmons (R-Conn.), who had supported the bill, last week announced his opposition to the legislation, a move that has led to some "nervousness about more potential GOP defections," CongressDaily reports. Rep. John Sweeney (R-N.Y.), who had supported the bill, said that currently he is undecided on the legislation, and Reps. Jim Gerlach (R-Pa.), Jim Ramstad (R-Minn.) and Frank LoBiondo (R-N.J.) also are "seen as potential vote-switchers," CongressDaily reports. In addition, Rep. Walter Jones (R-N.C.), who last month did not vote on the bill, is expected to vote against the legislation because of spending reductions for rural pharmacies (CongressDaily, 1/27).

Charity allegedly bilked seniors of millions

From the AP via Gainesville.com:

A charity and its sister nonprofit organization that claimed to help disadvantaged children received $5.3 million in donations from retirees across the country but sent only about $110,000 to the needy, according to authorities and documents.

Federal tax returns and accounting records showed that less than 2 percent of the funds donated by retirees to the Global Mindlink Foundation and Select International Donors since August 1999 went to charity, the South Florida Sun-Sentinel reported Sunday.

Analysis of more than 170 recorded phone calls from June 2005 showed that telemarketers pressured senior citizens for donations, and were able to get checking account and other information. Some donors seemed confused or hearing-impaired.

Pearl Jones, 88, of Saginaw, Mich., told a Global Mindlink employee in a June 28 recording that she was not sure she had $216 in the bank to donate. Jones said she was taking medicine and had suffered two heart attacks, but the nonprofit group withdrew the money from her bank account.

Lori Griffus said she told the companies earlier to stop calling Jones, her grandmother, who has difficulty hearing. But Jones lost about $3,000 to the two nonprofits, Griffus said.

Some donors were charged $490 for a "membership," while others paid $49.95, and in return received a newsletter with word puzzles, the Attorney General's Office alleged in a consumer protection lawsuit settled last week. Some of the puzzles had no solutions.

Company officials used funds for such expenses as a $2,885 stay at a Key West hotel and a $301 meal at a Boca Raton restaurant, examination of more than 700 pages of court documents and sworn statements, along with more than 1,500 pages of financial records showed. The Attorney General's Office obtained the records after the two companies shut down and left the papers behind in their shared office.

Read the rest of this story.

Ed:  Check out the FBI's Senior Fraud page for more information on the top senior scams.

Republicans target middle class seniors for budget cuts

From the Courier-Post On-line:

On Feb. 1, the House of Representatives will vote on a controversial law affecting most U.S. senior citizens. The proposed law, referred to as the Deficit Reduction Act of 2005, would create a complete overhaul of our Medicaid system with respect to assets and nursing home care.

Under current law, gifts provided beyond three years of the Medicaid application are allowed. Under the proposed law, states will be required to look back five years to determine if gifts were provided. For example, if an elderly parent gave a gift to a child 59 months ago, the Medicaid application will be denied under this new law. Also under the proposed law, our senior citizens would have to produce five year's worth of financial records before a Medicaid application could be approved.

According to current Medicaid laws, a person can gift a small portion of his or her life savings to family members and still qualify for Medicaid. The exact amount that can be protected is based on the value of the estate, the amount of the gift and when the gifts were provided.

The proposed law would not allow any gifts of any amount during the previous five years. Therefore, if a mother transferred $11,000 to her daughter in 2001 and 2002, she would not be able to qualify for Medicaid at this time, even though she has no assets. She would be denied Medicaid for a period of time in 2006. Under the current law, these small gifts provided in 2001 and 2002 would have no relevancy to the Medicaid application today.

The proposed law would make it difficult for senior citizens to protect their life savings and assets for the benefit of their families in the event they require nursing home care. Under current law, there exists legal methods to protect a portion of the assets from the catastrophic cost of nursing home care that can easily exceed $100,000 a year. Under the proposed law, most senior citizens would not be able to protect even a small portion of their life savings for their family.

The proposed law would create undue hardship on families if a parent or spouse requires nursing home care. The proposed law affects the use of annuities, the protection of assets for a healthier spouse and, in many cases, a home will no longer be protected if the equity exceeds a certain amount.

The proposed law barely was approved by the Senate on Dec. 21.  Vice President Dick Cheney had to cast the deciding vote.

If you are concerned about this proposed law -- tagged S.1932  -- tell your Congressional representative.

 

Read the rest of the story.

Gender, Ethnicity Sway Choices for End-of-Life Care

From Forbes.com

When it comes to end-of-life care, researchers have known for some time that ethnic groups have different perspectives on how they'd wish to be treated.

Now, a small study suggests there's a gender gap even among people of the same ethnicity.

Interviews with focus groups in Michigan revealed that female African-Americans and Latinos are more likely to want doctors to pull out all the stops to keep them alive. In contrast, men say they'd prefer to be allowed to die, said lead author Sonia Duffy, research investigator with the Ann Arbor VA Medical Center and the University of Michigan.

The researchers also found that Arab-Americans and African-Americans have starkly different expectations of where they want to spend their last days.

"For Arabs, going to a nursing home is the worst thing that could happen to you. The strong expectation is that your family takes care of you," Duffy said. "But African-Americans were more comfortable going to a nursing home, as they did not want to 'burden' their families."

The findings appear in the January issue of the Journal of the American Geriatrics Society.

Duffy cautioned that the study is small. Researchers interviewed 73 Michigan residents in 10 focus groups divided by ethnic or racial group -- white, black, Latino and Arab-American -- and gender. Their average age was 67.

Despite the study's size, the findings suggest doctors need to consider ethnic, racial and religious factors when they talk to families about end-of-life care, Duffy said.

The researchers asked focus group participants how they'd wish to be treated if they had six months to live.

Individuals differed greatly on the role of medical technology in extending life. According to Duffy, there were big differences among men and women in the African-American and Latino groups.

"The men generally did not want extensive intervention done. Dying with dignity was very important, and they didn't want to be a 'vegetable,' " she said.

Duffy added that many men appeared to feel that being dependent at the end of life was a threat to their masculinity.

By contrast, "women were more hopeful that God might intervene and things might change."

These types of gender differences suggest that spouses need to understand where each other stands on end-of-life issues, Duffy said. "It's important to get couples talking," especially since women tend to live longer and often find themselves making decisions for their partners.

Read the rest of this story, or check out the full article. 

CMA Open Letter re: Medicare Part D

The Center for Medicare Advocacy has sent Congress this 

OPEN LETTER REGARDING MEDICARE PART D:
TIME TO RETURN TO THE DRAWING BOARD

Recently, in editorial pages around the nation, the call has gone out to fix
the stumbling Medicare Part D program.  While we agree that the Medicare
prescription drug program has stumbled badly, it's high time to recognize
that it can't be "fixed". The real problems lie in the very structure of
Part D.  It is unfortunate but true that Medicare Part D was designed to
move Medicare from a successful, uniform program aimed at providing access
to health care for people with Medicare, to a dizzying array of private
plans intended to benefit the pharmaceutical, insurance, and managed care
industries.  Indeed, because of this, Part D can hardly be referred to as a
"program".  That's why Medicare consumers and advocates are overwhelmed and
dissatisfied, and the powerful industries benefiting from Part D are still
cheerleading, silent, or insisting that all we need is to fix a few
glitches.

Medicare prescription drug coverage should be part of the traditional
Medicare program.  There should be a uniform national plan, available to all
who qualify, which can be accessed from anywhere in the country.
Experience shows that this is best and that it can be done. 

Medicare was enacted in 1965 because private insurance failed to meet the
needs of older people.  At that time only 50% of people over 65 had health
insurance.  The Medicare program worked successfully and cost-effectively,
providing health insurance for 95% of people over 65, and, beginning in
1972, also for millions of people with significant disabilities. The
traditional Medicare program succeeded where private insurance had failed. 

More recently, experiments with returning to private insurance for
people with Medicare also failed.   One need not think too far back to
remember Medicare+Choice, and the hundreds of private plans that abandoned
Medicare beneficiaries in droves despite the Government's massive subsidies.

Everyone who cares about older people and people with disabilities should
insist that we stop wasting time and resources on this poorly conceived Part
D plan. It's time for Congress to return to the drawing board to enact a
true Medicare drug program that is aimed first and foremost at helping
people.

President Bush explains Medicare Part D

Bush Explains Medicare Drug Bill -- Verbatim Quote

WOMAN IN AUDIENCE: 'I don't really understand. How is it the new plan going to fix the problem?'

Verbatim response: PRESIDENT BUSH:

'Because the -- all which is on the table begins to address the big cost drivers. For example, how benefits are calculated, for example, is on the table. Whether or not benefits rise based upon wage increases or price increases. There's a series of parts of the formula that are being considered. And when you couple that, those different cost drivers, affecting those -- changing those with personal accounts, the idea is to get what has been promised more likely to be -- or closer delivered to that has been promised. Does that make any sense to you? It's kind of muddled. Look, there's a series of things that cause the -- like, for example, benefits are calculated based upon the increase of wages, as opposed to the increase of prices. Some have suggested that we calculate -- the benefits will rise based upon inflation, supposed to wage increases. There is a reform that would help solve the red if that were put into effect. In other words, how fast benefits grow, how fast the promised benefits grow, if those -- if that growth is affected, it will help on the red.'
Got that?

Ed:  Forward this to others -- so they, too, can understand...
Thanks to Ruth Ratzlaff. for this item.

AoA posts fact sheet on federal reimbursement of states for Part D costs

AoA has posted CMS's "FACT SHEET State Reimbursement for Medicare Part D Transition January 24, 2006" which begins:

CMS's state reimbursement plan enables States to be fully reimbursed for their efforts to help ensure that their beneficiaries eligible for Medicare and Medicaid have access to their covered Medicare drugs as they move to their new Medicare Part D drug coverage. The plan also supports limiting the need for State reimbursement by supporting the use of Medicare payment systems whenever possible, and promotes the effective transition of dually eligible Medicare beneficiaries into their new Medicare coverage. Background The Centers for Medicare & Medicaid Services (CMS) has taken numerous actions to ensure that full benefit dual eligibles, those eligible for both Medicare and Medicaid, continue to receive needed medications as they make the transition from Medicaid coverage of their drugs to coverage under the new Medicare Part D drug benefit. CMS is committed to working with States to make the transition as seamless as possible for all dually eligible beneficiaries. To ensure that the Medicare and Medicaid programs can respond expeditiously to the needs of the dual eligible beneficiaries, this state reimbursement plan will allow States that have assisted their dual eligible populations in obtaining and accessing Medicare Part D drug coverage to be reimbursed for their efforts. In particular, the demonstration plan will permit Medicare payment to be made to States for amounts they have paid for a dual eligible’s Part D covered drugs, to the extent that those costs are not otherwise recoverable under Part D. In addition to providing Medicare funds to reimburse amounts paid by States for Part D covered drugs, the demonstration would also provide payments for administrative costs incurred in the coordination of the drug benefit by State Medicaid programs. CMS will establish a staff team to provide expedited review of applications of States applying for this demonstration.

Read the full document at http://www.aoa.gov/Medicare/news/media/124PartDTransitionDemoFactSheet.pdf

Richard Kaplan on Taxes and Care Providers

The astonishingly prolific Professor Richard Kaplan has just published "Federal Tax Policy and Family-Provided Care for Older Adults" in the Virginia Tax Review (vol. 25, no. 2), Fall 2005 issue, pp. 509-562. It's available on SSRN at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=877491

Here's the abstract:

An issue of enormous and increasing significance to the vast majority of older Americans, and their families, is who will care for them as they age and require assistance in their daily lives. Such assistance is usually denominated  "long-term care," because it is a chronic phenomenon that is not limited to some specific medical incident. Such care can be provided in a variety of settings, depending upon the intensity of the older person's needs and the medical nature of those needs, but 80% of long-term care is provided by family members and close friends on an informal and typically unpaid basis. This phenomenon reflects a wide range of cultural norms in this country, as well as certain economic realities. As more Americans attain ages at which some assistance with daily life activities is typical, the federal tax treatment of family-provided elder care will become increasingly important.

This Article considers how the provision of informal care for older family members is taxed presently and how such treatment should be changed in light of changing family dynamics. It begins with a brief description of what informal elder care consists of and the impact of such care responsibilities on the family members who provide that care. The Article then considers how courts have assessed informal caregiving in the context of gratuitous transfers by the recipients of such care. It then examines the tax treatment of informal caregiving as it relates to the personal exemption and the deduction of medical expenses. The Article next analyzes a number of recent legislative proposals that would provide tax credits for family caregivers. The Article concludes with some policy responses to this growing societal concern.

Not elder law: World's oldest tortoise is ailing

From NDTV.com (India)

A giant tortoise in a Kolkata zoo believed to be 255 years old is ailing as caretakers struggle to keep it alive.

Referred to as Adwaitya meaning incomparable, it is probably the oldest living creature on Earth.

About 130 years ago Governor General Lord Clive brought it to the zoo.

The tortoise has a ventral infection and has been refusing food and drink for the past week, say veterinary doctors.

According to the Director of Alipore Zoo Dr S Choudhury it is an Aldabra giant tortoise brought to the zoo in 1875.

"The ventral side of the tortoise is cracked, vets apply appropriate medicine everyday".
Choudhury added that after a long treatment the tortoise is in better condition and hoped it will recover soon.

A Galapagos tortoise has a normal lifespan of about 250 years.  Adwaitya has crossed that mark, his admirers want him to reach his three century mark.

New Tutorials from KaiserEdu.org

New and updated on kaiserEDU.org...

• Medicare 101 Tutorial
• Medical Malpractice Policy Issue Module
• Addressing the Nursing Shortage Issue Module

• Long-Term Care Tutorial New!

This new narrated slide tutorial provides an overview of the financing of long-term care in the U.S., explaining issues related to the cost of long-term care, how families pay for long-term care services, and the role of the Medicare and Medicaid programs.

Updated:   

• Medical Errors Issue Module

This updated issue module provides new research and analysis on information technology, systems for reporting errors, and staffing issues, such as the impact of a nursing shortage. The issue brief provides background materials and links to key data, policy research, and webcasts and presentations on the topic.

Also updated:

• the directory of health policy fellowships contains new opportunities for undergraduates, graduate students, and professionals;

• the syllabus library now includes new course materials on Health Economics, International Health, Aging and Public Policy, and many more topics.

National Academy of Social Insurance--conference presentations now on line

From Jon Forman (who should probably get credit as a contributing editor to Elder Prof Blog):

Check out the powerpoints from the National Academy of Social Insurance’s recent conference

Older and Out of Work: Jobs and Social Insurance for a Changing Economy
January 19-20, 2006 ~ Conference Presentations Just Posted!

http://www.nasi.org/

Sharon's doctors consult long-term care experts

From Reuters International/SwissInfo:
   

Israeli Prime Minister Ariel Sharon's doctors consulted on Wednesday with specialists from a long-term care facility that claims a high success rate for awakening comatose patients.

A spokeswoman for Jerusalem's Hadassah hospital, where Sharon has been in a coma since a massive stroke on January 4, said the 77-year-old leader remained in critical but stable condition.

With Sharon showing no signs of waking up, two intensive care specialists from Loewenstein Hospital Rehabilitation Centre in central Israel were brought in for consultations with his doctors, the spokeswoman said.

She gave no word on whether he would be moved there.

The Loewenstein Centre says on its Web site that close to 86 percent of comatose patients in its neurological intensive care unit have recovered consciousness, a figure it described as one of the highest in the world.

Some vets denied health care coverage by VA

Via the Kaiser Daily Report:

"The Department of Veterans Affairs in the fiscal year that ended Sept. 30, 2005, denied enrollment for health coverage for 263,257 higher-income veterans without service-related injuries or illnesses as part of an effort to reduce costs, the AP/Los Angeles Times reports. VA suspended enrollment for such veterans in January 2003. At the time, VA estimated that the suspension would affect about 522,000 veterans through FY 2005 for a savings of $780 million. Rep. Lane Evans (D-Ill.), a member of the House Veterans Affairs Committee, said that additional veterans might not have attempted to enroll because they were aware they did not qualify for health coverage under the suspension. According to some lawmakers and veterans groups, Congress should allocate more funds for the VA health care system (Gamboa, AP/Los Angeles Times, 1/24).  "There is no reason ... to give the cold shoulder to veterans who have served our country honorably," Evans said (AP/Arizona Daily Star, 1/25). However, others maintain that VA must establish priorities for which veterans receive health coverage. "Our first priority is to care for veterans who were hurt or disabled in service and who need our help. We are doing that," Jeff Phillips, communications director for House Veterans Affairs Committee Chair Steve Buyer (R-Ind.), said. VA spokesperson Matt Burns added that the department provides high-quality health care to veterans, "particularly our newly returning veterans, those with low incomes and those who have sustained service-related injuries or illnesses"

The Colbert Report: Dr. Love on Medicare

http://www.comedycentral.com/sitewide/media_player/play.jhtml?itemId=49955

Ed.:  'Nuff said.

Froma Harrup on Medicare Part D

Via TomPaine.com:

By Froma Harrup

Once again, we have mob scenes of citizens begging for direction from their inept federal government. The botched launch of the Medicare drug benefit may not match the muddled response to Katrina in total tragedy, but it is causing trips to emergency rooms. Meanwhile, alarmed state officials are setting up crisis centers to ensure a continued flow of pills to their elderly and disabled populations.

How much more of this can the voters take? The Republicans running Washington are incapable of either designing a rational program or implementing it. And for all their talk of being the party of national security, you wonder how they would handle an unexpected terrorist attack when they can't even organize a drug plan with more than a year's lead time.

Many seniors who signed up for the program are learning that they are nowhere to be found in the government's computers. Pharmacists can't locate the needed billing information to fill prescriptions. And people calling the Medicare hotline face hour-long waits to speak to a human being.

The situation is even more frantic for low-income Medicaid patients, whose drug needs are now supposed to be met by Medicare. Some are being charged $30 for a prescription they're supposed to get for $3.

Usually, a government program that costs far more than necessary at least delivers gold-plated benefits with Swiss efficiency. But the Medicare drug benefits are mediocre. And Washington's performance would be an embarrassment in a Third World country.

The notion that $724 billion should buy a pretty nifty program is based on the pre-Bush assumption that the objective was to help elderly Americans obtain their medications. At this price, you'd expect things to run as smoothly as a Microsoft annual meeting. And the Medicare hotline would be staffed by banks of velvet-voiced experts who answer on the first ring.

But the real mission was to force through another adventure in privatization. The Republicans' idea of a "free market solution" is a government program that lets private companies siphon out billions--and hides the unremarkable level of benefits in the fog of "choice."

When you look at the program from the corporate point of view, it is a model of K Street efficiency: Insurance and drug company lobbyists hire Republicans and fill GOP campaign coffers. In return, they get to write the legislation to their liking. From this perspective, the drug benefit is working like a charm.

The drug companies were able to insert a provision that forbids the federal government to buy drugs in bulk at a negotiated price. And by dividing the purchasing power among hundreds of insurance companies, each with far less clout than the government, they can reap higher prices for their products.

Read the rest here.