Another development is the launch of private sector-developed tools that allow one to better navigate Medicare Part D. For example, the recently launched tool by Destination Rx allows users to compare plans and select the coverage option that might best suit an individual. I started looking at it http://www.drx.com/medicare-partd/compare/intermediate.aspx and have found it to be useful.

I see those tools – as you mention above – as American ingenuity solving uniquely American problems.

Would a parallel government plan really compete on an equal footing with private plans? Would it take risk or would the risk all be on the taxpayer? Would it pay taxes, pay for its facilities and insurance?

And how would the government plan choose to balance the issue of access and cost? Would it have a broad formulary or a narrow one?

The answers to these questions will determine whether the healthy competition within Part D will continue or be replaced by a single, government-run plan.

It must be galling to those who opposed Medicare Part D that it is so successful. A government program that offers good choices at good prices. Perhaps these opponents should put aside the desire for a government run plan and focus instead on improving enrollment by low-income beneficiaries and seeking needed changes to further improve the benefit especially for those low income beneficiaries who may not qualify today for the special, low-income assistance.