Medicare has no control over the Medicare Part D prescription drug plan. It is the insurance companies and HMOs who will run Part D. Of course they will do this for their own profit. And Medicare is not allowed to even bargain for lower prices. Huge cost overruns are expected as prices go up. Those will come out of Medicare funds and endanger Medicare itself.

Should I sign up for this vicious program? My first impulse is to say no. But the answer is not so simple. My husband got a mailing from the AARP Part D plan. Their charge for $3,600 of medicine is $2,960, a “savings” of $760. Suppose drug prices continue to rise at the present rate of 14 percent a year. The plan’s cost for the same medicines goes up to $3,919 in two years. That’s more than $3,600, the total cost without the plan two years earlier. But the cost outside of the plan would be $4,679, which is $760 more.

This Medicare Part D is a rotten law. It must be scrapped and replaced by a real drug benefit. While we work to change the law, many will join. If they don’t join, they will end up paying $4,679 instead of $3,919 for medicines that were already overpriced at $3,600.

For people on Medicaid, there is no choice. They are automatically put into Part D. They can choose their private Part D company. Otherwise they will be assigned to a supplier. People in state prescription drug plans are also required to join Part D and choose a supplier.

Some folks have drug coverage as union retirees. Others have bought prescription drug coverage. Save the letter from the plan that says you can stay in. Usually, staying with the plan you have is the best option. In my case, it is cheaper for me to buy my medicines in Canada than to join Medicare Part D. If I change my mind and enroll past May 15, 2006, I will suffer a 1 percent a month penalty to the premium (forever) for enrollment.

There are bills in Congress that can start to get us out of this mess. One would allow Medicare to be a supplier instead of limiting Part D to private companies. This bill also gives Medicare the right to bargain for lower prices. Another bill, introduced by Rep. Jan Schakowsky (D-Ill.), recognizes that people on Medicare need more time to figure out what to do. The bill extends the enrollment-without-penalty period for one year.

Help in deciding what to do is available in some cities, like Chicago, from the local Department of Aging. However, they are understaffed, so busy signals are very common.