David Catron has a superb column today on the Medicare Part D prescription drug program. He notes that it has set the stage for making the case for free-market reforms within Medicare. Its costs are about 40 percent below earlier estimates. Both the premiums paid by individuals and the cost to the taxpayers have been well below the original projections. Plus, the bill in question actually provided for Health Savings Accounts (HSAs) throughout the health-care system, not just in Medicare — a big win for conservatives, and, for that matter, especially for Rick Santorum, who had led the fight for HSAs for 11 years.
I know more than the usual about all this. For just over a year, I worked as a PR person helping run the effort (project manager) to fight off a Democratic bill to have government “negotiate” insurance prices for Part D rather than letting the market work. It was THE free-market fight of 2007. Thank goodness, we won. The reason we won was because the statistics were all in our favor. When Part D was passed, the Dems wanted to set the monthly premium at $35 (with subsequent hikes for inflation) because they feared the market would drive prices much, much higher than that. Good thing conservatives didn’t let them. When the smoke cleared, the average premium, even after two years, was about $24 — $11, or about 30%, LESS than the Dems would have insisted upon. Five years later, the average premiums are still well below Democratic projections; the reason for the lower prices is speficially because government “negotiators” were kept OUT of the system.
So Catron is right on all those counts.
Now, does that mean I would have voted for Part D in 2003? No. I opposed it with every fiber of my being. It was an unfunded expansion of an entitlement, and its free-market reforms were applicable only to Part D, not throughout the whole of Medicare. I argued then, and still believe today, that in return for expanding the entitlement so drastically, Congress should have included it as part of a systemic reform of all of Medicare, in order to avoid the bankruptcy of the system and all the other ills that stem from an out-of-control, bureaucrat-centric entitlement.
I also objected, vociferously, to the utterly corrupt method by which Tom DeLay and company, with the help of the Bush White House, pushed the bill through the House after holding the vote “open” for three hours, beginning at 2 a.m., while twisting arms and even using tactics and alleged tactics that really threatened the line of legality. It was one of the most corrupt congressional actions of my lifetime. It was sickening.
All of which leads us….. where? Well, it means that Catron is right that those in the SENATE (which didn’t use the same corrupt tactics) did at least have some decent reasons for supporting the bill — especially Santorum, whose HSAs were the culmination of 11 years of good, conservative work. Nonetheless, it still probably was a net minus for the cause of good government. And those in the House who voted for it are all guilty of aiding and abetting not just fiscal irresponsibility, but also corruption (at least procedural, and maybe otherwise) of the sort that ended up stinking so badly that it contributed mightily to the GOP losing the House AND (indirectly) to Obama becoming president.
(If I had been in the House and in FAVOR of the bill, I would have switched my vote AGAINST, and urged others to do so, in order to protect the integrity of the House.)
In sum, conservatives looking back at it should understand that Part D did some good, that the Senate vote wasn’t as bad as the House vote, and that the political pressures in favor of it were substantial. It STILL was a bad bill. But, on the Senate side at least, support for it is hardly disqualifying for national leadership.