POLITICS/POLICY/PHARMA: Compare and contrast GWB and LBJ on Medicare

2_24_112205_teacher_sex2_smallJonathan Cohn takes a good look at the Medicare implementation now and then, in What Bush could learn from LBJ on Medicare. Not too surprisingly the current screw-up wasn’t evident in 1965, even though the Johnson Administration had only 11 months to implement an entire new program, as opposed to the Bush Administration’s 25 months to add a new one on.

It does have to be said that McClellan’s golden boy image is starting to look a little like his brother’s — he of the “I know nothing” attitude (If you don’t know what I’m talking about look under N here)

7 replies »

  1. Just so all of you have an idea what is really going on, read ’em and weep. Darn accountants and the new rules and regulations.
    Now President Bush want’s to make tax free HSAs even more portable with LARGER tax free deposits. (How can HSAs be more portable?) I didn’t mention you Matthew on my first radio show – Tax Free HSA / Live from Tampa Bay. Maybe I will this week if you say something good.

  2. Tom- not to stray too much from the point, but this blog has devoted much space and love to the concept of outcomes and evidence based medicine. This appears to be simply one form of ‘Consequentialism’. I know you are not promoting a system where the good intents of doctors is all that matters.

  3. Well, Eric, when we make incompetence a crime, there won’t be any difference. Until then, there is all the difference in the world. Consequentialism is evil.

  4. Matthew- 60% of everyone over 65 already had health insurance (privately or through gov’t jobs) just prior to passage in 1965.
    Your reasoning is equal to the distinction between the leaking of classified information vs. a whistleblower. If, in the end, the special interests and the federal bureaucracy are the winners, what is the significance of intent?

  5. Eric, I really don’t think one can credibly make that case.
    This isn’t an error in projections that were 15 years in the future, with unimaginable medical advances made in the interim. The administration was delibreately lowballing the cost estimate to get this thing passed. First off, the numbers nearly doubled in the space of a year. If that’s not evidence enough that the Administration was actively hiding the true cost of the program to get it passed, then remember that Scully threatened to fire an actuary if he told Congress of a much more credible higher estimate (which was still lower than the current estimate).
    For all that conservatives rail that Democrats institute programs like Social Security and Medicare to buy votes, those programs actually work pretty well. Someone was thinking about the policy, and the wonkiness comes through–they are a mix of policy and politics.
    This is the kind of program you get when you allow the politics to dominate utterly and all you care about is winning the next political cycle–when you’re trying to buy seniors’ votes, buying the support of pharma and PBMs, and being able to tell your true believers that you’re setting the stage for privatization which will help you take down social security, too.
    That’s the lesson here. Politics is what wins elections, but governing is about more than winning elections. Policy matters.

  6. OF course of course of course. On the other hand, GWB’s pet program costs nearly tripled between the time the bill was passed and about 6 months later! And at least while LBJ appeased all hi special interests too, at least he got a core group that really needed coverage, covered as the main thing he did. GWB (and his henchmen Delay et al) had a core mission of appeasing their special interests, any needed coverage was an accidental by-product.

  7. One could make the case that what GWB failed to learn is that the institution of new entitlements will always cost far more than expected (remember that the number crunchers for medicare in 1965 estimated costs of $9 billion in 1980— the actual was about 10 times that amount). One could also make the case that the approach of appeasing all major players like LBJ did will eventually cause the entire system to be at serious risk of failure and collapse.