How do I want to mess you up, Part D? Let me count the ways...

Then: Decide having only 150 operators is adequate to deal with pharmacies' eligibility questions

Now: Oops! Actually 4,500 seems like it might work better

Then: Designing a drug benefit where "benefit" = $$$ for pharmaceutical companies

Now:  HHS secretary declares the benefit will be instated "One pill at a time,":

Leavitt added, "When there's change, there's an opportunity for things to go wrong. We are fixing them one pharmacy, one beneficiary at a time"   Leavitt and CMS Administrator Mark McClellan said "tens of thousands" of low-income beneficiaries have experienced problems obtaining drugs (USA Today, 1/18). "We are likely to see these problems on an ongoing basis until everyone has used their card at least once,"

Then: Witnessing the disaster unfolding, states come to the rescue!

Now:  The fed could care less -- they won't reimburse the states a cent!

The federal government will not reimburse states that are covering the cost of prescription drugs for Medicare beneficiaries who are unable to obtain medications under the new drug benefit. . . McClellan said, "Under this program, [CMS doesn't] have the authority to pay states directly," adding, "People are in Medicare drug plans and it's the Medicare plans that are supposed to pay for the medications"

Then: Medicare Part D will open smoothly, no problems expected

Now: We're going to go temporarily single-payer and require that insurers cover a 30 day supply for all prescriptions taken before the benefit. 

Yes, Medicare, Bush loves you.  It might be tough, but it's love.