Now all Americans know for sure what they'll be doing during their golden years: puzzling for weeks over — and perhaps uttering Anglo-Saxon oaths about — the new Medicare prescription drug benefit.

Just ask any of the 42 million Americans already enjoying retirement, or those disabled who are receiving Medicare.

With the launch of the initial sign-up period last week — it runs until May 15 — these seniors are grappling with a government program practically guaranteed to drive them 'round the bend. Just listen to the howls of protest.

There's something terribly wrong when people with doctorates say they're befuddled by the drug plan. What about the rest of us?

Medicare recipients have to choose from among dozens of private providers of the benefit, yet no two plans offer exactly the same coverage. The monthly premiums differ, as do the drugs covered by each plan and the co-payments required at the drugstore counter.

It's tough enough for consumers to compare apples and apples. The Part D decision phrases the question like this: Is this apple better than ... oh, how about that aardvark?

That's because Congress and the Bush administration wanted to inject competition and choice into Medicare, but were ideologically unwilling to do that in a sensible way. Choice is fine, but in areas as complex as health benefits, government has to organize the market, has to create a rational, comparable array of options, for choice to be meaningful.

As a Brandeis University scientist told the Boston Globe recently, "Choice is a wonderful thing until it paralyzes you."

Seniors certainly were not clamoring for such dizzying choices.

On paper, this private-sector approach has potential benefits. If for-profit benefit managers can hold down costs, and plow some of the savings back into enhancing the drug benefits, consumers could benefit. There are important incentives, as well, for businesses to retain company-based retiree drug plans — further stretching dollars.

Some retirees have no private drug coverage; federal officials assure them that it's worth their time to figure out which Part D plan is best. They insist that three out of four Medicare recipients will save money on drug costs by enrolling.

But those savings are predicated on millions of retirees actually figuring which Part D plan is right for them. That's quite a leap, given the complexity of the process.

Individual seniors without existing drug coverage had better pay attention as best they can, though. Even if they're not taking aspirin right now — let alone prescription drugs — it's important that they sign up for a Part D plan by the deadline. How so? They'll pay a hefty premium penalty if they sign up later.

One fall-back strategy: Sign up for a placeholder plan, one with a low monthly premium. Then, switch to a better plan next year if needed. (Find information at 1-800-MEDICARE or at www.medicare.gov online.)

Medicare was a health insurance program whose central virtue was its simplicity and universality, but whose main pitfall was its rising costs. Part D will spend billions of borrowed federal dollars to expand choices, but at the expense of simplicity.

The experiment may teach congressional leaders and the White House a surprising lesson: Americans do not always find choice and competition superior to a straightforward, government-run entitlement (like "old" Medicare).

— The Philadelphia Inquirer