After John Boehner was elected leader of the House Republicans in 2006, Fox News host Chris Wallace asked him what was, at the time, an obvious question: “Medicare prescription drug benefit,” Wallace said. “How do you think it’s working?”
This might have been a moment for Boehner to brag about one of the Republican Party’s most significant legislative achievements. Or, if politics didn’t permit patting himself on the back, perhaps he could have tried some elegant spin. But Boehner didn’t mince words: “The implementation of the Medicare plan has been horrendous,” he replied.
This wasn’t news. In 2003, Republicans had passed, and President George W. Bush had signed, the Medicare Prescription Drug Improvement and Modernization Act. The process itself was notorious: Republicans intimidated Medicare’s actuary into withholding cost projections and, after the bill looked to be failing in the House, held the vote open for hours past the deadline as Republican leaders twisted arms and promised payoffs. In 2004, the House Ethics Committee issued a “public admonishment” to Republican Majority Leader Tom DeLay for essentially bribing a fellow Republican for his vote.
In 2006, the bill went into effect. It was a disaster. Computer systems didn’t communicate with one another. Seniors were confused. Some of the poorest and sickest enrollees -- “dual eligibles” who qualify for aid under both Medicare and Medicaid -- weren’t able to get their drugs. It was so bad that in his 2006 State of the Union address, Bush “said nothing about the new Medicare prescription drug program, an initiative Republicans once hoped to trumpet but has angered many seniors in its implementation,” reported the Washington Post.
Washington was so consumed by the blame game that even non-politicians felt moved to defend themselves. “I was offended by a Jan. 14 front-page story that said that one problem with the Medicare Part D prescription drug program is poorly trained pharmacists,” wrote one Washington Post reader. “As a pharmacist, I want to say that we were dealt a lemon with this program.”
A 2006 hearing before the Senate Special Committee on Aging could’ve been a moment for Democrats to hammer the prescription drug bill. Instead, Senator Herb Kohl of Wisconsin, then the top Democrat on the panel, said it was important “to put aside any partisan thoughts to work together to get this program running.” Hillary Clinton, then a senator from New York pushing an alternative prescription drug plan, was similarly constructive. “I voted against it, but once it passed I certainly determined that I would try to do everything I could to make sure that New Yorkers understood it, could access it, and make the best of it,” she said. She went on, in true Clinton fashion, to recommend an informational brochure her staff had put together.
The kinks in the program were eventually worked out. Today Medicare Part D is widely considered a success. Costs have come in below expectations -- though in large part because pharmaceutical companies have invented fewer expensive new drugs than expected. Seniors are happy with the program. The Republican Party considers it a huge achievement -- even a model for future policies. “Our reforms draw upon the lessons of Medicare’s prescription drug program,” promised Representative Paul Ryan. Democrats, rather than attempting to repeal or overhaul Part D, used the Affordable Care Act to expand it.
There are lessons here about the difficulty of implementing large programs, the dangers of extrapolating from a program’s first months to gauge its long-term success and what it means to be a loyal opposition. The Republican Party isn’t learning them.
Republicans have done everything possible to keep Obamacare from getting up and running smoothly. They’ve refused to sign off on any budget that includes the necessary money for implementation. At a hearing last week where Senate Finance Committee Chairman Max Baucus of Montana warned of a “train wreck” if the rollout wasn’t effectively managed, Senator Orrin Hatch of Utah, the ranking Republican on the committee, attacked Health and Human Services Secretary Kathleen Sebelius for implementing the law with existing funds.
“A quick review of the HHS budget in brief seems to suggest that you are diverting funds from other areas of the department to put toward implementation,” Hatch said. “Would you describe the authority under which you believe you have the ability to conduct such transfers and whether or not you believe the Congress should be notified when these transfers occur?”
Consider the implicit argument there. The Affordable Care Act is the law of the land, and the Obama administration is legally bound to implement it. Having denied the necessary funding to do so, Republicans now want to hinder the administration’s ability to transfer other funding, to ensure that Obamacare becomes the disaster Republicans have promised.
The more horrendous the rollout, the more effectively Republicans can run against Obamacare in 2014. That might work: I wouldn’t be surprised to see Obamacare end up as a net negative for Democrats in the 2014 election -- much as Medicare Part D was for Republicans in 2006. But by the 2016 presidential election, it’s likely to be a law that Democrats brag about and Republicans scamper to get behind. And the final act of this depressing little political play will be Republicans embracing this policy that they did everything to destroy, and trying to build on it.
Don’t believe it? Some Republicans are already arguing that Ryan’s Medicare premium support plan simply brings Obamacare to Medicare. “The great irony of Obama’s triumph, however, is that it can pave the way for Republicans to adopt a comprehensive, market-oriented healthcare agenda,” wrote Avik Roy and Douglas Holtz-Eakin, two influential Republican policy advisers. They argue that “both Representative Paul Ryan’s ‘premium support’ proposal for Medicare and Obamacare’s exchanges are modeled on the Swiss system,” and that Republicans should push to have Medicare beneficiaries “gradually migrate into the exchanges’ premium-support systems.”
See? Republicans can go from arguing that Obamacare should be repealed to arguing that it needs to be expanded in a flash. But not until they’ve squeezed every political benefit from making its implementation disastrous.
(Ezra Klein is a Bloomberg View columnist. The opinions expressed are his own.)
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