25 October 2013

Prescription for OIP Derangement Syndrome

As President Barack Obama’s administration fixes the new federal health-insurance website, it’s valuable to compare responses to that endeavor with responses to the last administration’s big foray into health benefits: Medicare Part D.

The Washington Post described how that law was enacted for President George W. Bush in 2003: “During the vote, which was of unprecedented length, the House Republican leadership cajoled, berated and twisted arms, barely controlling a conservative revolt…” A June 2004 article in the Millbank Quarterly noted that was “by far the longest known roll-call vote in the history of the House.” Majority Leader Tom DeLay promised a favor to one reluctant Republican which later brought him a public admonition from the Ethics Committee. In the end that bill passed in the House 220-215 with members of both political parties on both sides.

Almost immediately the law’s price tag changed, as the Washington Post reported in 2005:

Beginning with his January 2003 State of the Union address, Bush pledged to keep the total cost of the drug benefit to $400 billion over 10 years. An estimate by the Congressional Budget Office was close to Bush’s figure.

But shortly after Bush signed the program into law in December 2003, the White House revised its projection to $534 billion, but it never offered a detailed breakdown of that estimate.

Last March, Richard S. Foster, Medicare's chief actuary for nearly a decade, said administration officials threatened to fire him if he disclosed his belief in 2003 that the drug package would cost $500 billion to $600 billion. . . .

As recently as September, Medicare chief Mark B. McClellan said the new drug package would cost $534 billion over 10 years. Last night, he acknowledged that the cumulative cost of the program between 2006 and 2015 will reach $1.2 trillion, but he cited several major savings and offsets that he said will reduce the federal government's bottom-line cost to $720 billion.
Medicare Part D was a big contributor to the budget deficits that the Bush-Cheney administration left to its successor. (In contrast, the Congressional Budget Office estimated that the Affordable Care Act would save the federal government money over ten years because it would make our use of health care more efficient.)

When Medicare Part D finally went into effect on 1 Jan 2006, there were lots of problems. On 18 January, the Washington Post reported on “tens of thousands of elderly and disabled Americans, their pharmacists, and governors struggling to resolve myriad start-up problems.” In particular, the paper had already said, the “online interactive tool…pitched as a high-tech way to help the 43 million Medicare beneficiaries sort through all the drug coverage choices” had run into troubles and missed deadlines.

Meanwhile, Tom DeLay left office under an ethical cloud. His replacement as House Majority Leader in early February 2006 was John Boehner. That Ohio representative had voted for Medicare Part D but had not been part of the party leadership at the time and therefore bore limited responsibility for the law.

On 6 Feb 2006, five weeks after Medicare recipients were supposed to start enrolling, Boehner went on the friendly confines of FOX News Sunday and criticized one aspect of the program: “The implementation has been horrendous. We’ve made it far more complicated than it should be. . . . I think the implementation side continues to need to be improved.” The interviewer then turned to Boehner’s interest in “meat and potato issues” and his “perpetual tan.”

Talking Points Memo also quoted Rep. Joe Barton (R-Texas) as saying, “This is a huge undertaking and there are going to be glitches. . . . Rather than trying to scare and confuse seniors, I would hope that we can work together as we go through the implementation phase to find out what is wrong with the program and if we can make some changes to fix it, let us do it and let us do it on a bipartisan basis." That was on 15 Feb 2006, six weeks after the enrollment started.

And Rep. Nathan Deal (R-Georgia) said in the same forum: “Like most significant programs, the new benefit has not gone without a few isolated glitches and unexpected problems. But I believe that if there is anything wrong with the plan, most of it has been fixed and that that hasn't can be fixed over time.”

As late as 6 Apr 2006, more than three months after enrollment opened, Rep. Tim Murphy (R-Pennsylvania) insisted: “Any time something is new, there is going to be some glitches.”

None of those congressmen demanded that the entire law be repealed, defunded, or seriously delayed. None called for the resignation of Cabinet secretaries. None referred to the program as a horrible threat to the federal budget or individual freedom. None voted to shut down the government as it started or urged their states not to cooperate with it. And while many Democratic elected officials didn’t like aspects of Medicare Part D and the way it was passed, they didn’t do those things, either. The double standard apparent in the responses is a hallmark of OIP Derangement Syndrome.

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