“Legitimacy – Redux” – Duffy's Political Soapbox

“Proof of Life” that there are, in fact, Duffy readers out there who make it through the full postings was the happy result of a spirited challenge to the most recent entry, “Legitimacy.”

As I had apparently waxed on poetic regarding the good old days of Bush bipartisanship, it was pointed out to me that I had omitted a crucial vote that was both of consequence, and much closer and partisan that the other examples provided on the Bush legislative record.

And indeed it is true. Thus, in the spirit of Congress, I hereby revise and extend my remarks.

On November 22, 2003, the House voted to approve the Conference Report which created the Prescription Drug plan, better known today as Medicare Part D. The vote was highly partisan and controversial – GOP arm twisting had the vote continue long after the vote clock had run out – but was eventually approved in the House by a margin of 220-215; identical to Speaker Pelosi’s Saturday vote on her health care reform.1

I was led to believe by my questioning Loyal Reader, that the similarity in vote totals for the two health care issues were indicative of the challenge of health care – no matter who controls Congress – and that the largely partisan vote on Saturday was the sad but ultimately necessary act to pass reform in any political atmosphere, and not – NOT – a reflection on fractured Democratic support or a narrow, liberal, ideological agenda.

For instance, the Senate voted in favor of Cloture (which allows the legislation to come to a vote) by the impressive margin of 70-29, and passed the Conference Report 55-44, with ten Democrats supporting the legislation.2 More “troubling” Bush bipartisanship.

And the anomaly in an identical vote, six years apart on the same topic matter is more ironic than instructive.

In 2003, Republicans were voting to create a prescription drug benefit – as promised by candidate Bush during the 2000 campaign – by using the private market and competition to reduce costs. The Democrats were as united against that approach in 2003, as Republicans were in Saturday’s government takeover of health care.

The benefit of the 2003 vote, however, is that we have an opportunity to see how the Republican plan performed. In an April 2008 article, James Capretta noted the success of market competition in reducing costs:

“The drug benefit’s market-based tilt is not complicated. Medicare beneficiaries choose every year from among competing, privately run drug coverage plans. The government’s contribution toward this coverage is set at a fixed percentage of the average premium, and no more. If the beneficiaries want to enroll in a plan that costs more than the average, they can do so – but they, not the government, must pay the additional premium. This structure provides strong incentives for the drug plans to secure discounts from manufacturers and encourage use of lower cost products over more expensive alternatives. Drug plans that fail to cut costs risk losing enrollment to cheaper competitors.”3

Three years after its introduction, more than 1,800 private plans are competing for enrollment. Moreover, Medicare beneficiaries like the program, with surveys showing that 85% are satisfied with the coverage.4

Most important, in 2008, the average beneficiary premium was just $25 per month, well below the $41 estimated in the original prescription drug bill. And as a result, the government is saving money as well – at least it was during the end of the Bush administration.5

The Center for Medicare and Medicaid noted that the competitive design of the program was holding down costs for the government as well. The Center estimated that the costs to the government would be 40% lower – or $244 billion less – over ten years than originally predicted.6

I thank my friend, the Loyal Challenger, for bringing this vote to my attention so that the Bush legislative record would be more robust and comprehensive. But beyond the identical votes, there is very little to be gleaned from President Bush’s efforts six years ago in Mrs. Pelosi’s massive government-sponsored power grab approved on Saturday.

For starters, the Senate vote was bipartisan and the legislation was ultimately approved in 2003.

Attacked by the Right as an unjustified expansion of government and by the left as a terrifying opportunity to prove the natural cost savings instigated by competition, Medicare Part D ended up exceeding the expectations of its founders, providing lower cost drugs for seniors at a reduced cost to taxpayers, all through a market mechanism.

President Obama, Speaker Pelosi and Leader Reid are all headed in the opposite direction.

Duffy waits expectantly to see if Leader Reid can forge as bipartisan a majority as his predecessors did six years ago on his health care legislation.