"People here are rightly very frustrated and angry that they are paying more for what looks like the same medication as many people get at a lower price in other parts of the world," says Mark McClellan, head of the Centres for Medicare & Medicaid Services, the agency that administers the programmes.So is the rest of the rich world free-riding on America?
Those who get the subsidies, or have jobs administering the programme, create a powerful vested interest.
Several managed-care organisations were given the job of administering the programme more efficiently.
The programme's costs are usually shared by the states and Washington, with states administering the programme within federal rules.
Local authorities administer the programme from funds allotted to them by the Home Office; in Scotland, Argyll and Bute was one of the first authorities to sign up.
There are signs that mayors who administer the programme well get a reward at the polls while those who do not suffer.
A Unicef report shows that in the north, where UN agencies administer the programme, child-mortality rates have fallen below pre-Gulf war levels, while the rate in the rest of Iraq has climbed higher.
It is badly targeted, but it has calmed the streets; the piqueteros now administer the programme in places like El Tambo.Mr Menem, too, is focusing his campaign on the new poor: at his rallies, he promises to end hunger, and reminds his audience that they lived better when he was president.
All the SEC, which will administer the programme, has to do is "be patient enough to listen," he adds.The new incentives should encourage more of those who uncover wrongdoing to step forward, greatly reducing the number who tell nobody for fear of reprisals from their employer 30-400%, according to one study).
