A Republican president who set liberals’ hair on fire. A political and media establishment going to unprecedented lengths to bring him down. All while a crucial election looms.
Sound familiar? It might match our situation today, but the political landscape George W. Bush faced in 2003 was eerily similar. In the lead-up to the 2004 election, the Left, enraged over Bush’s bold decisions in the wake of the September 11 attack, waged a fierce political war to bring him down.
Bush turned then to a campaign promise to bring prescription drug coverage to Medicare, resulting in the Medicare Part D program, signed into law in December of that year.
It was, and remains, wildly popular with the public, including conservative voters.
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“It’s hard to believe that Bush would have won Florida in 2000 … or that he would have won Ohio in 2004 without” Part D, National Review editor Ramesh Ponnuru wrote, adding, “he won both states by small margins, and through them the Electoral College.”
It was less popular among the conservative intelligentsia, but their criticisms have not aged well. Part D has emerged as one of the major policy success stories in the last few decades, channeling free market competition to drive lower prices, better quality, and happy enrollees (read: voters).
But the key from a conservative vantage point is cost: More than 40% under CBO estimates, which is completely unheard of for a government program. For this reason, Part D stands as an example for how politically sustainable entitlement reform might someday be enacted.
“Now in its fifth year, Medicare Part D is costing 41% less than the Congressional Budget Office originally projected,” Tevi Troy and Michael Leavitt wrote in a 2011 review for the Hudson Institute, a conservative think tank, “And program participants give it high marks — satisfaction percentages among seniors are in the high 80s, impressive for any government program.”
As is plainly evident from the unfolding battle over President Trump’s Supreme Court nomination, much is riding on the upcoming midterm election. For this reason, Republicans eager to provide themselves every available advantage would be wise to turn, as Bush is, to Medicare.
First, Congress should repeal a change secured in secretive negotiations over a stopgap spending bill earlier this year that threatens the integrity of Part D’s incentive structure.
The change, widely regarded as a means to prop up insurance companies struggling to provide Obamacare coverage, arbitrarily (and with no public debate) shifted billions of dollars in costs from the insurance companies to the pharmaceutical drug companies.
This creates a significant problem: It severs the link between the product (drug coverage plans) and the costs. Under this policy seniors actually pay an astonishing five times more than their insurance providers. Companies selling a product they don’t have to pay to produce aren’t likely to do much to keep their costs low, which, incidentally, is the fundamental structural issue behind the dysfunction in the health care sector.
Secondly, there is a looming “coverage gap” created by Obamacare that will result in millions of seniors suddenly owing $1,250 extra to continue their current plans in 2020.
Saving seniors from a sudden spike in Medicare costs is an obvious political win, what golfers would call a “gimme.”
But it also serves a policy end. The change in question was put in by Democrats to penalize drugs still under patent, an arbitrary and capricious distinction. Doctors, with many years of medical expertise, prescribe medications in this country, and in many instances newer drugs are simply more effective.
With the critical midterms looming, time is of the essence. These are two health care victories that serve important policy goals and would pay immediate political dividends. Congress should move quickly to enact them.