December 02, 2003

Reading Medicare Status I (My Head Hurts)

I'm nowhere close to finishing the monstrous task of at least skimming through the 600+ pages of the medicare prescription drug legislation but even from the early pages I get the feel that this is like one of those complex medical problems that is fixed by multiple rounds of surgery. In such situations, you have some actions that are done that simply prepare for future surgeries but don't actually fix what's wrong in themselves.

I went into this project thinking that what's being done here is laying the groundwork for a future medicare bill in 2005. I've not seen anything yet to disabuse me of this. If the 2004 elections result as I think they will, 12-20 more Republicans in the House, 4-9 more Republicans in the Senate, it would become possible to take a second whack at the law, creating something a little less frightful.

Entitlements have always been the third rails of US politics by design. The creators of the programs have built in features that make it politically impossible to dismantle such programs even when they are clearly unsustainable or counterproductive. Welfare was clearly a failure in the '70s. In fact, it was distinctly counterproductive to the interests of the poor it was meant to serve yet it took two decades more before the politicians could fix it and the landscape was littered with the political careers of people trying to fix the system so it didn't hurt the poor.

We've known for going on 20 years now that there was a pharmaceutical revolution going on and that whatever social provision was made for medical care, it should include pills. Personally, I think that social provision should be done with the least government interference as possible but medical care shouldn't ignore the technical revolution that's replaced the expensive surgery with the comparatively inexpensive pill no matter what level of state coercion you have in the payment of it.

So assuming that this legislation had to do two things, get passed, and establish principles that would make it easier for the next Congress to change the system for the better, what signs would be in the text that would prove or disprove this thesis?

More thoughts on this later but so little of the commentary that I've seen against the bill addresses things from this perspective of the start of a long road to reform. It's really disappointing.

Posted by TMLutas at December 2, 2003 11:53 AM