It remains to be seen whether George W. Bush’s boast about his drug plan will rival his “mission accomplished” swagger on the deck of that aircraft carrier. One thing for sure is that it’s the equal in user friendliness to the income-tax form.
No one who gives a damn about the people needing the plan could have devised what Mr. Bush is calling “the greatest advance in health care for seniors” in two generations. This is a scheme invented by politicians and lobbyists who are oblivious to the pains, confusions and fears of the old, the sick and the helpless.
Can you imagine a person with advanced breast cancer having to get on the Internet and go to http://www.medicare.gov to find a plan that covers the drugs prescribed by her oncologist? This patient must find, among 40 or more plans, the ones that will pay for the drugs she is taking; then she must find a drugstore that will accept the plan she hopes to select.
When questioned about the plan’s incomprehensible complexities, the sadist who runs this operation, Secretary of Unhealthy and Inhuman Services Michael Leavitt, had the nerve to say, “Health care is complicated. We acknowledge that. Lots of things in life are complicated: filling out a tax return, registering your car, getting cable television. It is going to take time for seniors to become comfortable with the drug benefit.”
Finding the money to pay for the medicine to treat congestive heart failure is equated with ordering cable TV? It wouldn’t be the equivalent even if a person had to choose among 40 cable-TV services—but, of course, the government has made sure that cable TV is a monopoly, which makes choosing it a lot easier. How, pray tell, does someone suffering from advanced Parkinson’s disease get “comfortable” with wading through packets of insurance-company obscurantism in hopes of finding a plan that will pay for the medications prescribed? And what if the doctor changes the prescription to a drug not found in the plan that’s been chosen? Price comparisons are next to impossible, since none of the plans is alike. An acute diabetic will find it easier to do comparison-shopping at the local supermarket—at least the price per unit of a detergent or a dried prune is clearly marked.
No one concerned with the welfare or “comfort” of sick, distressed people—many of whom are disabled, dying or in intense pain—could have put together this hellishly cruel piece of private-public bureaucracy. Perhaps it’s understandable that a Congress and an administration that sanction torture abroad would have few compunctions about tormenting the sick and the old at home.
The rationale for what they have sardonically called the drug benefit plan is “choice.” The snots with their Adam Smith ties running around American Enterprise Institute, the Heritage Foundation and the Cato Institute support any scheme with the word “choice” in it. Choice is linked to another of their favorite words, “freedom.” No distinction is made between real choice, informed choice or idiot choice.
If you are asked to guess how many jellybeans are in a three-foot-high glass bowl, you’re being offered an idiot choice. In your ignorance, you may freely choose any number that comes into your head. If you pay to get a chance to make your idiot choice (because whoever guesses right gets a prize), you are gambling. The freedom then is not in which number you guess, but in your decision to gamble. Given that millions will have to make an uninformed choice in picking their drug plan, they are being forced to gamble. At the A.E.I. and the other think tanks/whorehouses, they may call that “freedom”; the rest of us might be inclined to describe it as racketeering on the old and infirm.
Choice is important. Without choice, there can be no free market. Even under socialism, free markets are necessary to plan and allocate wealth—because, without them, cost, price and value cannot be determined. Among the reasons for the disaster that was the Soviet Union, the absence of free markets ranks high. Hence, we have to put up with the wasteful, inconsequential varieties of breakfast cereal because, in that welter of nonsense, there are cereals that differ from each other in significant ways. Selecting one of them demands a real choice and a real market decision.
Dozens of insurance companies are at work enticing people eligible for the drug program to sign up with them, so there is competition aplenty. Competition, however, isn’t the same as a free market—least of all in this case, in which the government is subsidizing the insurance companies against loss. The people who invented the drug program have achieved a triumph of sorts by combining the sludginess of government with the piratical tactics of overly free enterprise.
The decision to build a drug-benefit program using private insurance companies was either criminal, in that the people involved took bribes, or the moronic outcome of a misplaced free-choice fetishism. A half-century of using private insurance companies to administer health programs has been a disaster, driving doctors out of business and patients crazy. Today, almost 30 percent of the trillions spent on medical care goes to administrative costs, huge amounts of which are attributable to the health-insurance industry.
Younger, healthy adults at the peak of their powers find dealing with the insurance companies beyond endurance. A mother with a gravely ill child reflects that, “It is hard to describe what it is like to be confronted with mounds of scary claims and bills when you have a 2-year-old who is extremely ill, who needs constant nursing and doesn’t have a great chance of surviving and to sit in a hospital room, on hold with the insurance company for 30 minutes or more, only to have your child start puking just as you get a rep on the line.”
Sick people frequently must choose between getting well and battling with their health-insurance company. A new occupation has sprung up in response to the Kafkaesque policies of the industry: people who hire on to do battle with the insurance companies. They charge as much as $200 an hour, and although they may be worth every penny of it, people signing up for help in paying for their medicine are, one must suppose, not able to afford this service. Once this drug program gets going, those who have fallen into its clutches will be foundering in paperwork.
Of late, George W. Bush has taken to stumbling about the world, going from one international conference to another where he is blocked, spurned and frustrated. He might consider sticking around the United States and doing for his drug program what he did for his Social Security cock-up. If he gets going from town to town selling his latest piece of compassionate conservatism, maybe we can get it junked and replaced with something that works.