Medicare Part D
HA545: Health Policy
Policies govern how we as humans behave in certain situations. They are what dictates what actions are appropriate for us to take, versus what actions are deemed inappropriate and even illegal. However, as part of an effort to not take away our free will and ability to think and act using our inner moral compass, policies are only developed when a reoccurring problem finally becomes so large that it comes to the attention of our policy makers. A great example of this involves our health. Health problems are a major concern for all humans. Everybody has health problems in one way, shape or form at one point in their life or another. And if it isn’t them having the health problem, then more than likely someone close to them is. Therefore, health problems affect policy makers as well. So with health issues being such a large problem, policy makers hear about them all the time, and therefore will warrant policies being formed.
Therefore, we can always assume that health status is impacted by public health policy, and this is something we have seen manifest itself since the beginning of health policy. For example, faced with the rising cost of medical care in the United States, President Lyndon Johnson, in 1965, enacted a new Medicare program made up of Part A and Part B, a bipartisan policy of the Social Security Act (Oliver 2004). Part A was created in order to cover hospital insurance. Part B was supplemental medical insurance. Initially, Part B covered the cost of prescription drugs, but was eventually shrunk down to only cover prescription drugs that were given out at the doctor’s office, excluding those drugs that were self-administered by the patient. So basically, although we understand prescription medicine to be a major portion of the healthcare process, prescription drugs were dropped because, at the time, their costs were though to be too high and too unpredictable. But to understand where Parts C and D came from, we must first understand how policy making works.
Policymaking is the name given to the process that policy makers must go through in order to create the policies that we live by. It is a logical sequence of events that, when understood, allow us to understand the process from the point when the policy makers recognize a need to the point when society adopts the policy into everyday life. But the policy makers aren’t monitoring regular civilian life to identify problems that they must then take action on. Problems reach the attention of the policy makers by the actions of stakeholders or lobbyists. These groups represent interested parties who use politics to put pressure on policy makers to take action (or non-action) that benefits them and the interests of those they represent. Their motive could be genuine, deriving from actual problems that people need policies for in order to fix. Or, their motive could be purely political in nature, meaning they act (or don’t act) only to benefit their political party. Either way, this is how policy makers learn of the problems of the common citizens.
These problems must then be organized so that they can be presented for serious discussion before any action is taken. Many ideas that get organized don’t make it very far, but some do. How? These ideas “meet several criteria, including their technical feasibility, their fit with dominant values and the current national mood, their budgetary workability, and the political support or opposition they might experience” (Kingdon 2010). Basically, an idea that gets brought to the table stays on the table because the policy makers believe that it could work, plain and simple. They aren’t going to spend their time working on something they don’t think will work in the first place. So once it meets those criteria, they move forward.
Once discussion and any changes have taken place, usually comes the part where the proposal is turned into a policy in the form of orders/laws which come from the policy. The policy then becomes official, which means it has been signed by the President and become actionable by the government to the pleasure of some interest groups, and the dismay of others. The policy must then officially become implemented, which means that money and people are dedicated as described by the policy in order to make it work. However, what was intended by the implemented policy isn’t always the effect that is seen, and so there is always an evaluation period to see the effect of the implemented policy, and to determine whether small changes to the policy are needed or not.
Keeping all this information in mind, Medicare Part D and its implementation was a hot conversation topic because it surprised a lot of people. To understand exactly how, we have to dissect all aspects of the situation surrounding its implementation.
Just as discussed, in order for something like Medicare Part D to remain on the table and make it through the entire discussion process all the way to implementation and evaluation, there were first stakeholders who had a vested interest in such a plan, and used their political power to make sure the policy makers’ attention was on the problems they wanted them to see. Who were they? These included physicians and other medical employees, democrats who believed that Medicare was absolutely integral to a social insurance system in order to protect our nation’s senior citizens, and republicans who want less government involvement in policies like Medicare and therefore see an opportunity to preserve the role of private business and health systems in the field of healthcare services.
So at the time Medicare Part D was being pushed, the political waters were right for it to be proposed. Two of the biggest factors that influence how legislation fares on its way to changing policy and the country is how the problem the legislation deals with is perceived, and who currently controls the fabric of governmental power. Lobbyists and interest groups can have a certain control over the political landscape by following the idea that if they want control over which policies are successful versus which ones aren’t, then they must skillfully magnify the danger of their problems while skillfully drawing eyes away from other problems. This, of course, although effective, isn’t 100% the way to get their policies across or to prevent other policies they don’t want. They also realize that each policy maker is their own person, who has their own values and their own political ideologies that affect how they see the world and its problems and the policies that affect those problems. So it helps to push policy at a time when the overall political majority have ideology similar to yours, or at least who’s political agendas could in some way be aided by the policy being pushed. So how did this work in relation to Medicare Part D?
For all Americans, prescription drug prices were skyrocketing (Freudenheim 2003). A very large portion of Medicare beneficiaries were not receiving any form of assistance to help with prescription drugs, and republicans controlled government. With the rising costs of prescription drugs and Medicare beneficiaries struggling to get them, prescription drugs was no longer just an issue that came alongside some other major healthcare issue that everybody focused on with prescription drugs being affected by policy as an add on. For the first time, prescription drug prices and aid for Medicare beneficiaries was the primary problem that government had to deal with. The political environment was one that initially didn’t have this issue at the forefront of political minds, but in a very surprising but brilliant political move, the then-dominant republican party behind President Bush made Medicare reform one of their highest priorities.
Why was this surprising? Who would benefit, and why? For one, republicans would benefit. Republicans were fresh off a Presidential victory getting George W. Bush elected as the 43rd President of the United States. One of Bush’s running points was the promise to bring Medicare reform. So republicans feared a negative impact in the 2004 election if he couldn’t deliver. That would also give political power back to democrats. Medicare reform was originally a democratic idea, and so stealing this major issue away from democrats would put cracks in their platform. So with republicans behind President Bush taking credit for the Medicare reform, he would face much less opposition in the 2004 Presidential race. Because this was a move that would favor ideas coming from the democratic side of things, republicans in favor of this had to work harder to retain as many republican votes as possible, just as if a democrat were pushing this idea. A bipartisan agreement was crafted, and Vice President Dick Cheney convinced a good amount of republicans to changed their vote, a move that sealed the deal on the bill (Angle 2003).
So was the passing of this bill surprising? Yes. That a political party would literally adopt an idea from the opposing party in order to maintain political power shouldn’t be a surprising move to me, but it was a surprising move nonetheless. It seems that compromise ended up being the way for a these political parties to gain strength, and for the American people who are Medicare beneficiaries, to actually benefit. Neither group had to give up their core beliefs for this bill to pass, and actually, for that moment, brought the opposing parties closer together. However, the goal of the republicans, to maintain political power through the 2004 Presidential election, was met, with George W. Bush getting elected for his second term. Although Bush and the republican party lost their support by the time 2007 rolled around and their was a dramatic shift of power, for that moment, a goal was met that showed that a bipartisan agreement was possible, to benefit the American people that needed it.
Angle M. (June 2003) Difficult Medicare Conference Looms after Narrow House Passage. Capitol Spotlight.
Freudenheim M. (June 2003) Workers Paying a Larger Share for Drug Plans. New York Times.
Kingdon, J.W. (2010). Agendas, Alternatives, and Public Policies, Update Edition, with an epilogue on Health Care (2nd Edition) (Longman Classics in Political Science). Pearson
Oliver, T.R., Lee, P.R., Lipton, H.L. (2004). A Political History of Medicare and Prescription Drug Coverage. Milibank Quarterly 82(2): 283-354.
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