Like Matt Yglesias, I hope the “doughnut hole” coverage gap in Medicare Part D turns out to be a political disaster for its Republican designers this fall.
But reading this Washington Post story on the doughnut hole, I was struck by a blinding flash of the obvious. Because the coverage gap is defined by actual expenditure, not by prescription, a Medicare recipient with very big drug bills who can’t scrape up $2850 is out of luck for the rest of the year. It’s not as if he or she can just forgo $2850 worth of medicine, or get it in physician samples or under drug-company programs to assist low-income patients, and then start collecting again. There needs to be actual money on the table. So the program is well-designed for those to whom high drug prices are an annoyance, and badly designed for those to whom high drug prices are a catastrophe.
Good going, guys!