The Medicare Drug Plan is soon to come online and it looks, if possible, even worse than we thought. Not the benefit, which is fine, though highly complex, but the finances. As an opt-in program, the benefit needs healthy seniors to sign up in order to subsidize the poor and ill seniors who'll get most of the pay-outs. But because the plan is such a byzantine mess, most seniors don't want to sign up, particularly the healthy ones who simply don't need the trouble. That of course means only the ill and impoverished, the ones whom the benefit will help most, will take the time to navigate its rules, and so we'll have an insurer's nightmare: a pool filled with cash drains and totally lacking in healthy payers.

It didn't have to be this way. A normal plan could've been established where Medicare offers an 80% copay on prescription drugs in addition to an income-dependent premium. All seniors would've been enrolled, but there would've been an opt-out procedure for those who liked their current coverage. It would've been simple, it would've been understood, and it wouldn't have been financial unsustainable. Instead, we tried this weird conservative spin on an entitlement program, gave the whole thing to drug companies, pacified Republicans by making it opt-in, let multiple insurers be responsible for it, and generally created something no one understands and no one wants to use. And if no one wants to use it, only those who need it will. There goes the bank account.