By Harold Meyerson
Wednesday, January 25, 2006
Incompetence is not one of the seven deadly sins, and it's hardly the worst attribute that can be ascribed to George W. Bush. But it is this president's defining attribute. Historians, looking back at the hash that his administration has made of his war in Iraq, his response to Hurricane Katrina and his Medicare drug plan, will have to grapple with how one president could so cosmically botch so many big things -- particularly when most of them were the president's own initiatives.
In numbing profusion, the newspapers are filled with litanies of screw-ups. Yesterday's New York Times brought news of the first official assessment of our reconstruction efforts in Iraq, in which the government's special inspector general depicted a policy beset, as Times reporter James Glanz put it, "by gross understaffing, a lack of technical expertise, bureaucratic infighting [and] secrecy." At one point, rebuilding efforts were divided, bewilderingly and counterproductively, between the Army Corps of Engineers and, for projects involving water, the Navy. That's when you'd think a president would make clear in no uncertain terms that bureaucratic turf battles would not be allowed to impede Iraq's reconstruction. But then, the president had no guiding vision for how to rebuild Iraq -- indeed, he went to war believing that such an undertaking really wouldn't require much in the way of American treasure and American lives.
It's the president's prescription drug plan (Medicare Part D), though, that is his most mind-boggling failure. As was not the case in Iraq or with Katrina, it hasn't had to overcome the opposition of man or nature. Pharmacists are not resisting the program; seniors are not planting car bombs to impede it (not yet, anyway). But in what must be an unforeseen development, people are trying to get their medications covered under the program. Apparently, this is a contingency for which the administration was not prepared, as it has been singularly unable to get its own program up and running.
Initially, Part D's biggest glitch seemed to be the difficulty that seniors encountered in selecting a plan. But since Part D took effect on Jan. 1, the most acute problem has been the plan's failure to cover the 6.2 million low-income seniors whose medications had been covered by Medicaid. On New Year's Day, the new law shifted these people's coverage to private insurers. And all hell broke loose.
Pharmacists found that the insurers didn't have the seniors' names in their systems, or charged them far in excess of what the new law stipulated -- and what the seniors could afford. In California fully 20 percent of the state's 1.1 million elderly Medicaid recipients had their coverage denied. The state had to step in to pick up the tab for their medications. California has appropriated $150 million for the medications, and estimates that it will be out of pocket more than $900 million by 2008-09. Before Jan. 1 the Bush administration had told California that it would save roughly $120 million a year once Part D was in effect.
California's experience is hardly unique. To date at least 25 states and the District have had to defray the costs to seniors that Part D was supposed to cover. What's truly stunning about this tale is that, while officials may not have known how many non-indigent seniors would sign up of their own accord, they always knew that these 6.2 million seniors would be shifted into the plan on the first day of the year. There were absolutely no surprises, and yet administration officials weren't even remotely prepared.
No such problems attended the creation of Medicare itself in the mid-1960s. Then, a governmental agency simply assumed responsibility for seniors' doctor and hospital visits. But, financially beholden to both the drug and insurance industries, the Bush administration and the Repsublican Congress mandated that millions of Americans have their coverage shifted to these most byzantine of bureaucracies.
This is, remember, the president's signature domestic initiative, just as the Iraq war is his signature foreign initiative.
How could a president get these things so wrong? Incompetence may describe this presidency, but it doesn't explain it. For that, historians may need to turn to the seven deadly sins: to greed, in understanding why Bush entrusted his new drug entitlement to a financial mainstay of modern Republicanism. To sloth, in understanding why Incurious George has repeatedly ignored the work of experts whose advice runs counter to his desires.
More and more, the key question for this administration is that of the great American sage, Casey Stengel: Can't anybody here play this game?