The title of the editorial says it all, "Part "D" for "Defective" -- The Medicare Drug-Benefit Chaos".

It's a pretty good dissection of the disaster of the new Bush administration drug-benefit. Just think Katrina meets healthcare.

In many cases, the program worsened patients' situations, with a particularly heavy burden falling on indigent Medicaid enrollees. Before the new entitlement, most had virtually all their medications covered fully by the states. But on January 1, 6.2 million of these vulnerable elderly were reassigned to one of the private insurance companies designated by Medicare to run its program. Word of these arrangements didn't always reach the patients, insurers, or pharmacies accurately, and tens of thousands of indigent patients were told to get prior authorization, pay a large initial deductible, or make substantial copayments for regularly used medicines they previously received at no cost.[2] Thousands discovered that the drugs they had been taking for years were not covered by their new insurers. Clinical crises ensued, and 37 states had to provide emergency payments for frail citizens.[3]

Despite its youth, the Medicare drug benefit is already chronically ill. But with extensive rehabilitation, it could go on for years, albeit with impaired functional capacity. Debate continues over whether its early spasticity was caused by inept management of its birth or a genetic disorder present at its creation.
...
As with other nature-versus-nurture debates, the correct answer to the question of causation is "both." The drug benefit was defective from its conception and then malnurtured at birth. Its legislative history was marked by heavy input from the pharmaceutical and insurance industries, with predictable results.
...
The new law prohibited the government from negotiating with pharmaceutical manufacturers for lower costs, though nearly every country that guarantees drug coverage to its citizens does so. Lobbyists argued that it wouldn't be fair for drug companies to have to negotiate prices with such a powerful buyer. Yet Medicare has different rules for less influential vendors: it sets the prices it pays physicians, hospitals, laboratories, nursing homes, and essentially every other recipient of Medicare funds.

The lesson is simple, with powerful enough lobbyists congress will make laws that benefit you, even if fundamentally unfair, or inconsistent with laws that apply to other people. Sorry, I guess that was obvious. But then, NEJM suggests the Give UP model will correct the problem:

Medicare Part D lives on, responding semiappropriately to noxious stimuli by flailing its limbs as best it can. It even shows some limited capacity for learning, and one important learning opportunity is just seven months away. Elderly citizens vote in droves, and many of them will have hit their "doughnut hole" by early November. At that point, they will let their legislators know how they feel about the program.