Insurance commissioners in at least 39 states are investigating the use of illegal tactics to sell private Medicare plans. People with mental disabilities and dementia have been sold health insurance they didn't want and didn't need, state officials have said. In some cases, miraculously, salespeople appear to have sold policies to the dead.

The New York Times and Washington Post reported last week that at least 22 states have received complaints about fraudulent signatures on insurance applications. Many others are looking into improper hard-sell tactics. Oklahoma's insurance commissioner, for example, completed a major investigation this month documenting widespread misconduct.

Industry groups maintain that the kinds of abuses described in a recent survey by the National Association of Insurance Commissioners are the work of a handful of unscrupulous agents. But two significant, mainstream Medicare insurers — Humana and WellCare Health Plans — have been implicated in possible misconduct.

The root of the problem is the staggering complexity of a Medicare prescription drug bill passed by a Republican-controlled Congress in 2003. Under the provisions of that bill, drug benefits are available only through private health insurance companies. But these same companies also offer a version of managed care for those eligible for Medicare called Medicare Advantage plans. These plans combine drug benefits with coverage for other health care services traditionally covered by Medicare. However, unlike traditional Medicare, which allows patients to choose their own doctors, the managed care plans may put limits on where care may be provided and by whom. In addition, patients often are charged a monthly fee to enroll in Medicare Advantage plans.

Many of the current crop of complaints to state insurance commissioners involve people who only wanted — and thought they only were signing up for — Medicare drug plans. They later discovered that they had been steered into enrolling in managed care plans.

Oklahoma's investigators, for example, reported that some agents used bait-and-switch techniques to get into elderly people's homes, then pressed hard to sell the managed care plans.

When the federal Medicare drug bill originally was approved, proponents argued that private plans would provide competition for Medicare. The many available options would allow elderly people to pick the plan that would work best for them.

But the dozens of available choices in each state also have been used to provide cover for high-pressure salesmen who manipulate their targets into more expensive plans.

Seniors aren't the only victims when such abuses occur. A federal Medicare advisory committee calculates that Medicare managed care plans cost taxpayers 12 percent more per person covered than traditional Medicare costs.

Congress must establish stronger oversight of Medicare insurance plans and how they are sold. It needs to standardize benefits. That's what it did for so-called Medigap plans, which cover the 20 percent co-pay for traditional Medicare.

These new revelations suggest that, in some cases, the Medicare insurance plans create a kind of "competition" that comes at too high a price, both for the elderly and for taxpayers. Officials should pursue their investigations aggressively.

— St. Louis Post-Dispatch

• • •Alrighty then. We have now seen three presidential debates — two Republican and one Democratic — each of them featuring all of the "serious" candidates: 10 on the GOP side; eight on the Dem. It is time to start ruthlessly weeding the field. We, therefore, nominate Simon Cowell to moderate the next gathering.Cowell would call a laughingstock a laughingstock. He'd humiliate crackpots like former Libertarian fringe candidate Ron Paul, whose performance Tuesday proved him the Sanjaya of the political arena. Put Paul and the audience out of their misery.Although Rudy Giuliani shot down the Texas congressman's blame-America-for-9/11 declaration, Paul should not have had the platform. Yes, it is early in the race, but even so, higher stand-ards must apply. The 20-seconds-a-pop format has fulfilled its entertainment mission. Legitimate candidates should have more time to state their positions, the better to inform voters. Guys like Paul, sub-1 percent in the polls, waste everyone's time.On the Democratic side, the winnowing should start with Mike Gravel, a one-time senator from Alaska. He added levity to the debate but also presented outlandish notions. Like his plan for Iraq withdrawal: "You pass a law making it a felony to stay there."Can you imagine what Cowell would have done with that?

— New York Daily News