Who determines the overall cost of the new Medicare prescription drug entitlement?

Not government auditors. Not politicians. Not lobbyists. It's people directly affected by the 2003 law: America's growing senior population.

How? Participation in the drug program is voluntary, so an important factor in determining the cost is the number of seniors signing up in 2006, the first year the program is available. The trouble is, as Heritage health care expert Derek Hunter writes in a recent online paper, that number is hard to predict. "No one knows for sure how many seniors will sign up for the new benefit, either by choice or by being dumped into it by their former employers," Hunter says.

That's one reason why 10-year cost estimates range from $395 billion (Congressional Budget Office) to $534 billion (Centers for Medicare and Medicaid Services). But one thing's for sure: It will be a lot of money. Read Hunter's paper here:

How The Drug Entitlement Drives Different Cost Estimates
(April 1, 2004).

For more information or to receive an e-mail version of "Bitter Pills," contact [email protected] or call Heritage Media Services at (202) 675-1761.

"Bitter Pills" is an occasional, but regular, feature from The Heritage Foundation on how the 2003 Medicare drug law is full of sickening "surprises" that have serious consequences for seniors and taxpayers. Of course, The Heritage Foundation isn't surprised at all. We diagnosed the problems long ago in our Medicare Maladies series. Both Medicare Maladies and Bitter Pills are available on heritage.org (if you can stomach them).