Centerfield

"Personally, its hard for me to hear seniors "whine" about the complexity of the choices. So we're complaining that the government has given us "too many choices"?"

Before you say such things about us you should take a good look at what information has actually been presented to Medicare beneficiaries and find out what we actually will be confronting with the Part D program. There are 90 separate plan possibilities in Ohio alone.

Try figuring out for yourself, say, what your mother would have to do to get the best care under Medicare Part D by reading the vague and convoluted information that has been kited out so far.

Both myself and my companion have disability "case managers" who are there to help us negotiate the shoals of this program, and other social programs, as well as to help us meet other common social needs.

They are quite good, and highly professional about such bureaucratic nightmares as Food Stamps, home heating assistance, disability applications, Section 8 housing, and Medicaid.

But this country is barely 36 days away from Part D going into effect and the information about it is so byzantine and convoluted that even the professional case managers, who do this for a living, haven't a clue how it is really supposed to work.

Neither do the pharmacists.

Nor the doctors.

We use lots of medications (eighteen different ones for my companion, four for me) and have lots of doctor visits to many different specialists, sometimes on the order of as many as 3-4 a week. We talk to our doctors and our pharmacists a lot, as friends as well as patients.

They are clueless.

We are a little better off, but not much. We are "dual eligibles" who already have medical coverage through both Medicare and Medicaid. We were first alerted about all this all the way back in June, and we have been scratching around for any intelligible scraps of information concerning Part D ever since. We've not found much we could make heads or tails of, either.

But even the little we've found has put us in the position of being implored by our own case managers to go with them to the frantic Part D workshops happening now, where they are supposed to be getting the straight information, so the four of us can put our heads together to help them figure it out.

I strongly suspect that there is a specific political reason behind all this. The little we have been able to find out about Part D consistently suggests that virtually every senior in America will be in for some really ugly surprises anywhere between four and twelve months into coverage.

For example, there is the "doughnut hole", an upper dollar limit of Part D coverage where the government contribution stops immediately and totally, leaving you with the abrupt responsibility of suddenly covering your entire Rx drug costs on your own.

Of course, it is the sickest and neediest among us who will fall into the doughnut hole first. My companion's medications will push her into it sometime in mid-February after we start on January 1.

But I think the limit is so low that thousands of seniors are going to have the rug yanked out from under them with it, and be suddenly confronted with the need to come up with at least $1500.00 on their own before the drug coverage resumes.

Not only that, the law apparently bars them from carrying any secondary private coverage to take up the slack, so this will be a completely out of pocket expense for people generally living on frugal fixed incomes.

From what we can see, no one in the government has much interest in being straightforward about this. The moment we all find out how it really works, there will be an immense political explosion, and every Representive or Senator involved, as well as the President, will be ducking for cover in consequence.

This is another manifestation of a really irritating aspect of modern bureaucracy interacting with consumer benefits. It doesn't matter whetther we're talking about tax breaks, healthcare plans, or what.

Basically, the idea is that some big entity (the governmnet, a company, an institution) has an offer for a better deal. But to limit the number of people who take advantage of it, they turn the process of acquiring the benefit into basically a marathon test of not just intelligence, but will, tenacity, and vigilance.

For example, some people are eligible to set up medical spending accounts to pay for medical expenses, and they can fill these accounts with pre-tax dollars, so whatever they buy out of these accounts amounts to sheltering the original income from taxation. But if you put too much money in and don't spend it all in the given calkendar year, can you roll it over to the next? Can you just withdraw it an pay taxes? Nope, you just lose it if you don't spend it on qualified expenses. Where does it go?

So, if you make it complicated enough, only the people that are really driven to take advantage of it will do so. It's like taking grocery store coupons and mail-in rebates to a new level.

Another timely on-point example: today's Thursday Boston globe came with a 2-inch thick pile of holiday circulars, most of which offered special early-bird deals...buy a $1400 TV for $899, but only if you get there before 11 am. Oh and sorry, no rain checks, supplies are limited. How many does the store have on hand? Only the shadow knows.

I count myself among the very fortunate that I can simply opt out of such potential nightmare scenarios, on the rationale that it's simply not worth subjecting myself to it just to save $50 on a 20-inch LCD TV or $30 on a shop vac, or whatever. IMO, it's unfortunate that Americans are being asked to make a show of just how bad they want it. You have to want it bad enough to dance on cue to the piper's tune. But then no one's holding a gun to anyone's head, at least not yet. 6 AM in the mall parking lot tomorrow morning, it might be a different story.

Best of luck to the brave, the people-loving, and the simply desparate souls heading to shop-opolis tomorrow.

See what happens when you mention drug prices? :-)

Brian, the $30 shop vacs at Home Depot in Monroe, La. were gone 11 minutes after it opened. And they only had 80 of the drill that was advertised on the circular and on TV all day long.

Yup. Bait and switch.