But the Bush administration has already declared open season on 43 million Americans who depend on Medicare, as the drug and insurance industries join the Medicare prescription drug gold rush.

The pharmaceutical industry stands to gain $139 billion in profits from the prescription drug benefit. And the nation’s giant insurance companies are putting hundreds of millions of dollars into marketing campaigns to snag bewildered consumers into their private drug plans, subsidized by taxpayers.

Starting January 1, 2006, Medicare will offer limited prescription drug coverage to Americans age 65 and over and to younger Americans with serious and prolonged disabilities. That should be a good thing. Medicare, the best national health care system in our nation’s history, has lacked prescription drug coverage for far too long.

But the overdue response to a great national need—yes, older Americans routinely suffer and die in this country for lack of affordable medicine—has been corrupted into a profit-seeking feeding frenzy that will enrich powerful supporters of the Bush administration and leave millions of people with Medicare paralyzed like deer in headlights.

For the first time in the history of Medicare, there will be a Medicare benefit that is not available under the Original Medicare program—the government run fee-for-service program through which the vast majority of people with Medicare receive their health benefits. To get Medicare drug coverage, older and disabled Americans will now have to enroll in a private plan that provides drug coverage. They can choose a stand-alone drug plan that lets them continue to get the rest of their health benefits though Original Medicare. Or they can choose a managed-care plan, like an HMO, that will provide all their health benefits, including drug coverage.

In many parts of the country, people with Medicare—including the oldest, frailest and most disabled—will face upward of 40 competing drug plans. Each plan will have varying deductibles and premiums; differing and ever-changing lists of covered drugs; an array of co-payments for different prescriptions; special requirements to be met before certain drugs will be covered; and pharmacy networks that may or may not include an individual’s favorite neighborhood pharmacy.

Few of the men and women confronting this crazy-quilt menu of drug plans have the expertise needed to navigate the web of trapdoors contained in the competing plans. Many are cognitively impaired, homebound or living in nursing homes or suffering from chronic illnesses—both physical and mental.

Sure, some people with Medicare are sophisticated and healthy. But even experts are uncertain how to assist people in making informed decisions on whether to enroll in the benefit and, once that decision is made, which of the scores of plan options is the best bet to cover the medicines they may need by year’s end.

That is because this benefit defeats the main purpose of insurance: to have a safety net for an uncertain future. People with Medicare will be locked in to the drug plan they choose for a year, despite the fact that the drug plans can and will change the drugs they cover throughout the year.

Then there are the hundreds of millions of dollars that our nation’s leading health care corporations—companies like Humana, United Healthcare and MEDCO—will spend on marketing campaigns that will mostly mislead consumers.

Marketing, by its nature, emphasizes what will appeal to a prospective buyer. A plan with low premiums will trumpet the premium cost in its marketing; you will have to search the fine print to find any mention of corresponding excessive prescription co-payments.

Advertisements in the mail will be misleading enough. But even worse, the Bush administration—under heavy lobbying from insurance companies sponsoring the Medicare drug plans—earlier this year authorized telemarketing of these complex insurance products. Salespeople working for the insurers are allowed to call people with Medicare at home between 8 a.m. and 9 p.m.

Think about how straightforward and educational those conversations will be for our parents and grandparents.

Such marketing is not illegal. The Centers for Medicare and Medicaid Services, the federal agency that runs Medicare, has endorsed the system. And it gets worse. Like the profiteering insurers, the federal government is telling untruths and half truths about the drug program—sometimes by design, sometimes by human error.

The Bush administration spent millions of taxpayer dollars to distribute an insert in Parade magazine that ran in hundreds of Sunday newspapers across the country in mid-October. The insert was supposed to describe, in an educational and fair way, the Medicare drug benefit.

However—whoops!—the government insert neglected to mention the "doughnut hole"—a nearly $3,000 gap in coverage when people will have to keep paying plan premiums but will receive no assistance paying for their medicine. That makes the government’s promotion propaganda, not education. But hey, there’s money to be made.

And then there is the mailing of 43 million copies of CMS's annual handbook, Medicare & You. It contained a huge error: The handbook incorrectly stated that low-income people can sign up for any drug plan without paying unaffordable premiums. This particular mishap appears to be an error, not deliberate fraud. Still, people will be hurt if they rely on the handbook’s advice.

In the months ahead, commission-based insurance brokers will be driving the national campaign to enroll people in the competing drug plans. Of course, they will have every financial incentive to maximize enrollment in the plan they are selling. They will have very little incentive to help consumers make good choices from the array of confusing benefit options.

It’s a Darwinian marketplace, and the fittest are the insurance companies and their political allies. More people would have good health and longer lives with a drug benefit designed in the public interest—not private profit.

The corrupt design of this Medicare drug benefit will have to be fixed. There is a good chance that public anger over this ill-conceived program—and the public outrage over the industries’ ill-begotten profits—will trigger a fresh look at what works and what doesn’t work in health care.

Medicare, a national single-payer system relying on private doctors and hospitals, has been a national treasure for the last 40 years. The American people will judge the success of the privatized Medicare drug benefit starting this January. It will be a moment to ask out loud: For how long must our national health be held hostage to the commercial interests that profit from the suffering of ordinary Americans?