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January 19, 2006

How The Right Lost The Long-Game on Medicare

Nathan Newman makes the only political point worth making on the Medicare Drug Benefit:

Whatever the intentions of the GOP, the existence of Medicare Part D means that seniors now have an expectation that the government will help them pay for the costs of prescription drugs. And given how screwed up the plan is, that leaves plenty of political room for Democrats to advocate for improvements in the plan at the next election.

One reason I cheered when the bill was passed was that, despite its flaws, the dynamics of middle class entitlements are that they create a political feedback mechanism of demands for improvements. And whatever the short-term political gains for the GOP from passage of the original bill, ideologically the rightwing does not win by adding another permanent political issue of how to improve Medicare Part D to every election cycle.

Bingo. I've been beating this drum for awhile, but the long-term effect of Bush's Medicare expansion was to codify prescription drug coverage as a legitimate and expected use of the welfare state. Medicare is now a vessel for, among other things, prescription drugs. And if what currently inhabits the shell is a legislative clusterfuck, that can be fairly easily switched out for a coherent, efficient plan (like this one). And until it is, Democrats have an issue. Funny legacy for Medicare Part D, which was supposed to deprive Democrats of a perennial campaign issue and instead heightened its relevance and made Republicans look totally incompetent on the subject.

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The battle over entitlements is merely beginning, and will not become tragedy until the deficits meet the baby boom. The Republicans added Part D with the understanding that the starved beast will eat Medicare soon enough anyway, and that Part D was a tactical necessity for more budget-busting tax cuts.

I honestly don't know what will happen when taxes have to be doubled or entitlements halved.

Posted by: bob mcmanus | Jan 19, 2006 12:46:02 PM

...to codify prescription drug coverage as a legitimate and expected use of the welfare state

Precisely. Even a badly conceived and poorly implemented law broadening Medicare coverage is much better than nothing. It can be fixed, but it may require in-patient hospitalization to get it right. The very serious faults built-in deliberately by the Repubs will turn out to create irresistable pressure to make it a better law.

What is surprising is that it has taken this long to get into law the recognition that medical care has for decades become drug therapy - one can't be done without the other. We are now over that hurdle, and will argue over implementation matters.

Posted by: JimPortandOR | Jan 19, 2006 2:09:06 PM

Ah, but the beauty of the Bush tax cuts is that to double tax revenues, you don't have to double everyone's taxes. Just a few people will do.

That said, I fear Mark Schmitt's take on this is right once again: the GOP Part-D benefit was written by very canny people who expected it to fail, and are counting on the backlash. As he says, "the political goal of the Medicare drug bill was not to cement a new alliance between seniors and the Republican Party around a government program, but primarily to destabilize the old alliance" -- of seniors with Medicare and hence with government and hence with the party that actually governs, the (D)'s.

This puts GWB's tilting at the Social Security windmill into perspective. It was part and parcel of this same attempt to separate people from government, and hence to shrink the natural constituency for any governing at all.

Rescuing these programs from attack (with Part D, from itself) is not assured, and remains both excellent policy and fabulous politics for non-Republicans.

But all it is for now is a moment of opportunity.

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