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The lessons of Medicare Part D

Mathew Yglesias:

John Breaux and Bill Frist have an op-ed in Politico whose exoteric message is that Congress should use the 2003 Medicare bill as a model for bipartisan health reform. The esoteric message is a reminder that the easiest way to get a bipartisan deal passed is to just have bipartisan agreement not to pay for it at all. That was the secret to the 2003 bill. First you take something a bloc of voters want — in this case prescription drugs — then you figure out a way to provide it in a manner that’s very good for the interests of stakeholders in the business community. Easy as pie.

It is insane that the people who voted for the deficit-financed, $700 billion Medicare Prescription Drug Benefit are allowed to scream about fiscal rectitude this year. Just amazing. The occasional defense I've heard is that 2003 wasn't the middle of the most severe recession in memory. That's a defense in much the same way that poking yourself in both eyes so you can't see your assailant is a defense. Deficit spending makes more sense during recessions, not less. Deficit spending is also cheaper during recessions, as interest rates are lower because investors want to buy treasuries.

By the way, for those keeping score, the senators who voted for Medicare Part D and are still in the Senate are:

Lamar Alexander, Max Baucus, Bob Bennett, Kit Bond, Jim Bunning, Tom Carper, Saxby Chambliss, Thad Cochran, Susan Collins, Kent Conrad, John Cornyn, Mike Crapo, Byron Dorgan, Mike Enzi, Dianne Feinstein, Chuck Grassley, Orrin Hatch, Kay Bailey Hutchinson, James Inhofe, Jon Kyl, Mary Landrieu, Blanche Lincoln, Dick Lugar, Mitch McConnell, Lisa Murkowski, Ben Nelson, Pat Roberts, Pete Sessions, Richard Shelby, Olympia Snowe, Arlen Specter, George Voinovich and Ron Wyden. Lieberman did not vote.

None of these people have any authority to complain about the spending in health-care reform. When the CBO scored Medicare Part D, it concludes that the bill "would increase mandatory outlays by $407 billion for fiscal years 2004 to 2013 and would raise federal revenues by $7 billion over that period." In other words, it was a vote to add about $400 billion to the deficit in the first 10 years, and trillions more in the decades after that.

The health-care reform bills currently under consideration in both the Senate and the House actually cut money from the deficit, but they are being criticized as fiscally irresponsible by many of the people who voted for Medicare Part D. It's like watching arsonists calling the fire department reckless.

By Ezra Klein  |  November 16, 2009; 5:02 PM ET
Categories:  Health Reform  
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Small correction Ezra: Pete Domenici isn't in the Senate anymore (thankfully)

Posted by: Cyco | November 16, 2009 5:27 PM | Report abuse

Every time the budget chickenhawks spout that nonsense, we just need to ask them where the money for medicare part d, 2 rounds of tax cuts, and 2 failed war efforts will come from, before worrying about a program that REDUCES the deficit.

Posted by: srw3 | November 16, 2009 5:39 PM | Report abuse

Ezra your posts are always enjoyable reading! Keep up the good work.

It would be good to add that that $400 Billion estimate was conveniently updated to $533 Billion AFTER the bill was approved, and is now even higher than that.

I don't know how the Republicans get away with complaining about the deficit when they pushed through this program and Bush's tax cuts, which effectively make up half of our estimated national debt.

Posted by: kmani1 | November 16, 2009 5:49 PM | Report abuse

Amen. the spirit of the link -- radical ways to get real change....

Perhaps the best solution is go into the filibuster, let it block health care, and have *no reform*.

And even then pass the truly ineffective Republican reform.

And...let it play out.


Then, after the catastrophic Rep. plan and the health care bubble have collapsed, then Dems can move in and pick up the pieces.

Posted by: HalHorvath | November 16, 2009 5:51 PM | Report abuse

Health care is indeed a "bubble" just like housing was:

Posted by: HalHorvath | November 16, 2009 5:56 PM | Report abuse

I believe you mean Jeff Sessions, not Pete Sessions (he's a House member).

Posted by: HBurton1 | November 16, 2009 9:41 PM | Report abuse

Ezra, your hatred of Republicans makes your analysis stupid.

The Medicare Part D benefit "modernized" what was already existing as an entitlement. It included prescription drugs but the long term benefit to society is that by the elderly receiveing pharmeceuticals (which is the modern way to treat a lot of illnesses) it coule reduce more expensive surgical costs and other expensive treatments in the long run. Medicare Part D added a benefit to an existing entitlement.

The current health care reform, which I could also support, is adding on an entire new entitlement to health care to 30 million new people who have never before been entitled to health care. This is a much bigger deal.

Also, this is happening at a much more precarious time in our nations history. In the single month of October, 2009, this nation reported a deficit of $176 billion!

Finally, deficit spending is good during a recession. But you need it to be the non-recurring kind of deficit spending. Not on an entitlement program that is going to lock our nation in forever. Roads, bridges, broadband expansion. That is the type of deficit spending that is supposed to fill the gap during a recession and then can be eliminated after the gap of the recession is filled.

Posted by: lancediverson | November 17, 2009 9:56 AM | Report abuse

Two wrongs don't make a right. Neither do four. I am against both wars and both bills.

So can you support the repeal of part D now, Ezra. It's an abomination. Billy Tauzin should be in prison. If you don't support repealing it, do you support the tax increases necessary to pay for it?

Posted by: staticvars | November 17, 2009 10:18 AM | Report abuse

"The current health care reform, which I could also support, is adding on an entire new entitlement to health care to 30 million new people who have never before been entitled to health care."

They've always been entitled to health care. They just haven't received it.

Posted by: eRobin1 | November 17, 2009 10:40 AM | Report abuse

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