Plan D, the US Medicare drug plan that requires elderly people to sign up for a drug benefit, has been given a D for failure by a US Congressional representative in the New England Journal of Medicine (2006;354:2314-5). It “works better for the pharmaceutical and insurance industries than for beneficiaries,” she says.

Writing in a commentary, Congressional Representative Louise Slaughter of New York state, a Democrat and a microbiologist with a master's degree in public health, called Plan D “the worst abuse of the legislative process I have seen during my 20 years in Congress.”

Medicare's Plan D required all people older than 65 years to sign up for one of a confusing number of plans that offered …