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by Meg White
Fri, 07/10/2009 - 12:16pm.
In examining and crafting policy, it is helpful to look at the recent past. The favorite comparison for our current efforts to reform healthcare is known as Hillarycare, the failed attempt at universal healthcare during the Clinton Administration.
But there may be a much more timely (and ominous) yardstick to hold up to this current legislative process: President Bush's Medicare Part D prescription drug program for seniors.
I know 2003 was forever ago, but does anyone remember how we ended up with Medicare Part D?
It was promised as a mechanism to bring down prescription costs for seniors. The problem is, the legislation itself was basically written by Big Pharma. The drug companies ingeniously decided they wouldn't have to negotiate with the federal government on Medicare prescription drug prices, as they must do with other programs such as the Veterans Health Administration, so they could charge taxpayers whatever they wanted.
And that they did.
After all that, the program still didn't help a large minority of the senior population deal with drug costs because of the massive "doughnut hole" problem. There are millions of seniors caught in the so-called doughnut hole, where thousands of dollars in annual prescription drug costs must come directly from their individual pocketbooks, or they will go without the often life-saving medications.
The legislation had a "trigger" built in to supposedly protect consumers and taxpayers against huge cost increases in the program. If the bills became too large, a "public option" would kick in and tell Big Pharma what's what. Unsurprisingly, that threshold has not yet been reached.
As a result, Big Pharma got a big windfall (a whopping $3.7 billion in the first two years alone) from Medicare Part D. But hey, that's what happens when you let lobbyists for the industry you're trying to reform write the legislation that does the reforming.Now, that may seem like a narrowly-focused reform that has little to do with the massive overhaul our healthcare system needs right now. But the comparison is clearly something being bounced around the Oval Office, obvious thanks to a slip-up on Chief of Staff Rahm Emanuel's part in an interview with the Wall Street Journal this week (emphasis mine):
Mr. Emanuel said one of several ways to meet Mr. Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own.
He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.
The deal with the hospitals follows a similar agreement with brand-name drug companies. And insurance companies were talking to Senate negotiators about cuts worth at least $100 billion over 10 years, according to two officials with knowledge of the negotiations.
The article was picked up on in the media as a hint that the White House is going to collapse on its plan for a public option, in favor of the private co-op plan being marketed by conservative lawmakers of late. In fact, President Obama even felt it necessary to reassure those angling for true healthcare reform that he still supports a public option.
But the peep from Emanuel was telling. He says a "public plan" is only necessary if hospital bills balloon too large. That will set off a "trigger mechanism" like we were told would be available for the Medicare prescription drug program. You remember, that one which we haven't yet seen?
Now the House is using healthcare reform as an impetus to argue over ways to fix the doughnut hole problem, but they don't see the trigger pointed right in their faces.
Instead, Blue Dog Democrats are saying they want to work with industry to institute reforms. The[y] insist that the American Hospital Association is ready to help cut costs. Right. Just like Big Pharma promised to do for seniors with the failed prescription drug program we're trying to clean up now, just three years after it went into effect.
Lawmakers need only look back a few years in the past to see that trusting industry to institute a fair trigger guarantees yet another program blowing up in our faces.
