How about D as in "Demise of the party that passed this thing".
My prediction: Medicare Part D will take the Republican hegemony down. Not Abramoff. Not NSA illegality. Not Iraq or Iran. Not even a Social Security-privatization-type popular response to the proposed Health Savings Accounts. The biggest political catastrophe the Republican Congress and White House have faced yet in the Bush Era is Medicare Part D.
It's only fitting. Medicare Part D came into existence because Bush had to get elected and re-elected. Without the promise of a prescription drugs plan in 2000 and the actual bill on his desk in 2003, he wouldn't be president now, 911 or not. Toting a plan that was appealing to the phramaceutical industry helped Bush raise the funds to crush his opponent in TV advertising in 2000 and compete in advertising and GOTV in 2004.
But the political gains didn't end with money. In 2000, offering a partially-private plan allowed Bush to campaign against the idea of seniors being forced into a "big government HMO". Of course, seniors were already being shunted into a "big-government HMO" for all their other essential health needs: Medicare. Nobody wanted that to change, but by fudging the issue with his catchphrase, Bush was able to rail against Big Government and the HMO boogieman at the same time. Then, in 2004, Bush saddled up the uplifting, go-git-em-tiger mantra of "choice" to promote his domestic agenda, a motif into which his choice-heavy drug plan fit nicely along with HSAs and privatized public pensions. At the same time, it retained all the rhetorical gold of appealing to that Great Old American Free Market Economy and to Americans' deep sense of fatalism about losing control over their own lives in this crazy modern world.
The "market" part of the pitch was, of course, crap*. For "choice" to result in efficient price-at-marginal-cost outcomes, people need something close to perfect information about their options, sort of like what you have when you look at cans of soup on the grocery store shelf offered at different prices depending on the brand and ingredients. As with the soup example, consumers also have to be somewhat dispassionate. When the choices get opaque, complicated and/or overwhelming, and the stakes become high (like your ability to take your heart medication on time) people become extremely susceptible to advertizing and especially to emotional, quick-fix appeals. Technically, they start making economically irrational decisions, and, in particular, they make decisions that are only tangentially related to the price schedule they face. The economists -- and everybody else -- at PhRMA understand this. That's why they backed the Bush-GOP House plan so enthusiastically. The drug companies don't even have to engage in unseemly collusion, at least beyond K-Street, because competition for descerning seniors simply won't bid down the price of drugs. Only the monopsony power of Medicare could do that. And the Medicare Modernization bill, of course, contained a provision to directly limit Medicare's ability to do so by negotiating with the drug companies involved in Part D.
And that's not even getting into the reverse-insurance nature of the donut hole, or the entire classes of drugs that aren't covered by any of the plans.
The whole thing reminds me of the modern GOP's approach to spending: run (political) deficits and just hope something comes up so you don't have to pay the eventual inflated bill. But you do have to pay. And it starts now. Once old people start getting royally fucked and their middle-aged kids see what's happening (as happened for my family when my Dad spent a week wading through the 30-odd available plans with different drugs and different deductables to pick out what was, at least ex-ante, the best -- though because of brand-loyalty and caution, not the cheapest -- one for my grandmother), it's curtains for the party that passed this piece of shit bill. As Pelosi put it while fighting the bill on the floor of the House, "It's a party position". And it is. It's the difference between the party that believes in governing and the party that believes in finding ways to conceal the fact that it doesn't believe in governing. Don't forget that most GOP-leaning conservatarian orgs consider federal intervention in health care to be well-nigh unconstitutional.
There might be no easy answers for Democrats on Iran or the national security/privacy tradeoff. But there is an easy answer here. This is one battle the Democrats ought to be able to win by just saying and standing by what they believe.
* I wrote all this before reading Ezra's post over at TAPPED, which makes some of the same arguments, or Dean Baker's EPI study on the matter.
It's only fitting. Medicare Part D came into existence because Bush had to get elected and re-elected. Without the promise of a prescription drugs plan in 2000 and the actual bill on his desk in 2003, he wouldn't be president now, 911 or not. Toting a plan that was appealing to the phramaceutical industry helped Bush raise the funds to crush his opponent in TV advertising in 2000 and compete in advertising and GOTV in 2004.
But the political gains didn't end with money. In 2000, offering a partially-private plan allowed Bush to campaign against the idea of seniors being forced into a "big government HMO". Of course, seniors were already being shunted into a "big-government HMO" for all their other essential health needs: Medicare. Nobody wanted that to change, but by fudging the issue with his catchphrase, Bush was able to rail against Big Government and the HMO boogieman at the same time. Then, in 2004, Bush saddled up the uplifting, go-git-em-tiger mantra of "choice" to promote his domestic agenda, a motif into which his choice-heavy drug plan fit nicely along with HSAs and privatized public pensions. At the same time, it retained all the rhetorical gold of appealing to that Great Old American Free Market Economy and to Americans' deep sense of fatalism about losing control over their own lives in this crazy modern world.
The "market" part of the pitch was, of course, crap*. For "choice" to result in efficient price-at-marginal-cost outcomes, people need something close to perfect information about their options, sort of like what you have when you look at cans of soup on the grocery store shelf offered at different prices depending on the brand and ingredients. As with the soup example, consumers also have to be somewhat dispassionate. When the choices get opaque, complicated and/or overwhelming, and the stakes become high (like your ability to take your heart medication on time) people become extremely susceptible to advertizing and especially to emotional, quick-fix appeals. Technically, they start making economically irrational decisions, and, in particular, they make decisions that are only tangentially related to the price schedule they face. The economists -- and everybody else -- at PhRMA understand this. That's why they backed the Bush-GOP House plan so enthusiastically. The drug companies don't even have to engage in unseemly collusion, at least beyond K-Street, because competition for descerning seniors simply won't bid down the price of drugs. Only the monopsony power of Medicare could do that. And the Medicare Modernization bill, of course, contained a provision to directly limit Medicare's ability to do so by negotiating with the drug companies involved in Part D.
And that's not even getting into the reverse-insurance nature of the donut hole, or the entire classes of drugs that aren't covered by any of the plans.
The whole thing reminds me of the modern GOP's approach to spending: run (political) deficits and just hope something comes up so you don't have to pay the eventual inflated bill. But you do have to pay. And it starts now. Once old people start getting royally fucked and their middle-aged kids see what's happening (as happened for my family when my Dad spent a week wading through the 30-odd available plans with different drugs and different deductables to pick out what was, at least ex-ante, the best -- though because of brand-loyalty and caution, not the cheapest -- one for my grandmother), it's curtains for the party that passed this piece of shit bill. As Pelosi put it while fighting the bill on the floor of the House, "It's a party position". And it is. It's the difference between the party that believes in governing and the party that believes in finding ways to conceal the fact that it doesn't believe in governing. Don't forget that most GOP-leaning conservatarian orgs consider federal intervention in health care to be well-nigh unconstitutional.
There might be no easy answers for Democrats on Iran or the national security/privacy tradeoff. But there is an easy answer here. This is one battle the Democrats ought to be able to win by just saying and standing by what they believe.
* I wrote all this before reading Ezra's post over at TAPPED, which makes some of the same arguments, or Dean Baker's EPI study on the matter.
3 Comments:
One argument that Dems can make is that while capitalism is usually productive and efficient for companies, and, often, consumers, it can be INEFFICIENT for society as a whole. When certain entities in a capitalist society become too large, then others cannot negotiate with them effectively. That's why we have democracy - it allows individuals to band together and negotiate with those more powerful than themselves. Democracy is a means of giving capitalism competition.
In this instance, that would have meant Medicare being free to negotiate for lower prices for drugs. So, in this sense, the GOP solution was anti-capitalist, because it distorted the market in favor of one party (the drug companies), which introduces inefficiencies, and therefore makes the whole system LESS productive.
That comment above, from "dokcck" is actually from me, JohnTEQP. "dokcck" was the word verification that I was supposed to type in to publish this post. Oops!
Yay! Seven months of blogging and this is the first time somebody finally commented on the incongruity of my blog title.
Like I say, it's a tall order.
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