Medicare Part D A Successful Start With Room for Improvement

摘要

MEDICARE PART D REPRESENTS A BOLD EXPER1-ment to publicly fund, but privately sell and administer, prescription drug insurance. Part D is only a relatively small part of the overall Medicare program; Medicare spent Dollars 432 billion overall in 2007, of which Part D accounted for only 11.6% (Dollars 50 billion) } However, the Medicare program is so large that Part D alone should account for 1% of the entire economy in less than 2 decades.1 Furthermore, there is little room for more spending, given the trustees' recent forecast of Dollars 12 trillion in unfunded liabilities over the next 75 years梐 debt just slightly smaller than the entire US economy.1 So much appears to be riding on Part D's success or failure, including possible models for the provision of health insurance to the currently uninsured. Two articles23 in this issue of JAMA raise important concerns about the program, but must be rightly viewed in this larger context#