I came across a provocative research report written by Dean Baker at the
Center for Economic and Policy Research this month entitled
"The Savings from an Efficient Medicare Prescription Drug Plan" that goes beyond criticizing the current, failed approach. He projects the financial savings from having a simple add-on drug benefit to the basic Medicare package. In addition, using data from the Congressional Budget Office (CBO) and other sources, he projects separately the potential savings from having Medicare negotiate prices directly with drug companies and the savings from having a single designated administrator of the program, instead of insurance companies. Baker then compares the costs of a simple Medicare add-on with the cost of the Medicare Modernization
From the executive summary:
"The projected combined savings from lower drug costs and lower administrative fees are large enough in the middle-cost scenario to allow for the government to fully cover the porjected cost of perscription drugs for Medicare beneficiaries over this budget window, and still leave a surplus of almost $40 billion compared with the projected spending under the MMA (current Medicare Modernization Act)."
Baker notes that the GOP controlled Congress passed the MMA in 2003 ostensibly to help senior citizens pay for their perscription drugs, but because it was designed to allow private insurance companies provide the benefit instead of the Medicade administration, the end result was increased administrative and drug costs, as well as a program much more complicated for beneficiaries.
Instead, Baker argues that the program should be centrally administered as an add-on to the traditional Medicare program.
Also,
Healthy Policy Blog has more on the lobbying effort that ensured passage of Medicare Part D, referencing an article by Paul Krugman. Unfortunately, Krugman's article is behind a TimesSelect firewall, so here is the entire article (via Factiva):
The K Street PrescriptionBy PAUL KRUGMAN
20 January 2006
The New York Times
The new prescription drug benefit is off to a catastrophic start. Tens of thousands of older Americans have arrived at pharmacies to discover that their old drug benefits have been canceled, but that they aren't on the list for the new program. More than two dozen states have taken emergency action.
At first, federal officials were oblivious. ''This is going very well,'' a Medicare spokesman declared a few days into the disaster. Then officials started making excuses. Some conservatives even insist that the debacle vindicates their ideology: see, government can't do anything right.
But government works when it's run by people who take public policy seriously. As Jonathan Cohn points out in The New Republic, when Medicare began 40 years ago, things went remarkably smoothly from the start. But this time the people putting together a new federal program had one foot out the revolving door: this was a drug bill written by and for lobbyists.
Consider the career trajectories of the two men who played the most important role in putting together the Medicare legislation.
Thomas Scully was a hospital industry lobbyist before President Bush appointed him to run Medicare. In that job, Mr. Scully famously threatened to fire his chief actuary if he told Congress the truth about cost projections for the Medicare drug program.
Mr. Scully had good reasons not to let anything stand in the way of the drug bill. He had received a special ethics waiver from his superiors allowing him to negotiate for future jobs with lobbying and investment firms -- firms that had a strong financial stake in the form of the bill -- while still in public office. He left public service, if that's what it was, almost as soon as the bill was passed, and is once again a lobbyist, now for drug companies.
Meanwhile, Representative Billy Tauzin, the bill's point man on Capitol Hill, quickly left Congress once the bill was passed to become president of Pharmaceutical Research and Manufacturers of America, the powerful drug industry lobby.
Surely both men's decisions while in office were influenced by the desire to please their potential future employers. And that undue influence explains why the drug legislation is such a mess.
The most important problem with the drug bill is that it doesn't offer direct coverage from Medicare. Instead, people must sign up with private plans offered by insurance companies.
This has three bad effects. First, the elderly face wildly confusing choices. Second, costs are high, because the bill creates an extra, unnecessary layer of bureaucracy. Finally, the fragmentation into private plans prevents Medicare from using bulk purchasing to reduce drug prices.
It's all bad, from the public's point of view. But it's good for insurance companies, which get extra business even though they serve no useful function, and it's even better for drug companies, which are able to charge premium prices. So whose interests do you think Mr. Scully and Mr. Tauzin represented?
Which brings us to the larger question of cronyism and corruption.
Thanks to Jack Abramoff, the K Street project orchestrated by Tom DeLay is finally getting some serious attention in the news media. Mr. DeLay and his allies have sought, with great success, to ensure that lobbying firms hire only Republicans. But most reports on the project still miss the main point by emphasizing the effect on campaign contributions.
The more important effect of the K Street project is that it allows the party machine to offer lavish personal rewards to the faithful. For a congressman, toeing the line on legislation brought free meals in Jack Abramoff's restaurant, invitations to his sky box, golf trips to Scotland, cushy jobs for family members and a lavish salary after leaving office. The same kinds of rewards are there for loyal members of the administration, especially given the Bush administration's practice of appointing lobbyists to key positions.
I don't want to overstate Mr. Abramoff's role: although he was an important player in this system, he wasn't the only one. In particular, he doesn't seem to have been involved in the Medicare drug deal. It's interesting, though, that Scott McClellan has announced that the White House, contrary to earlier promises, won't provide any specific information about contacts between Mr. Abramoff and staff members.
So I have a question for my colleagues in the news media: Why isn't the decision by the White House to stonewall on the largest corruption scandal since Warren Harding considered major news?