While the task of narrowing the Bush Administration's offenses against the American people to one boggles the mind, I'm going to attempt it nonetheless. Outside the major refrains against the regime that all of us on the left are practically numb to after eight years, I think that Medicare Part D, the Bush-backed effort to extend Medicare benefits to cover prescription drug purchases, was one of the biggest mistakes made in an era characterized by presidential mistakes.
I chose this particular issue partly because of the magnitude of the initiative's impact, especially in economic terms (as a part of the $10 trillion hangover chronicled by Linda Bilmes in a recent issue of Harper's) and partly because, unlike many of the other controversial issues that Bush and his team left their dirty fingerprints on, this one isn't easy to excuse through ideology.
Unlike litmus test issues like loosening environmental regulations and narrowing civil liberties, where there a variety of defensible positions taken by different political parties, the Part D debacle is a sheer case of political cronyism (two of the bill's main Republican champions in Congress left soon after its passing for sweetheart jobs lobbying for the pharmaceuticals industry), cynical machine politics, and fiscal irresponsibility, all wrapped into one package. By using an issue guaranteed to resonate with voters (a high percentage of whom, after all, are in or close to the age range eligible for Medicare benefits), then tailoring the proposed plan to maximize private profits while minimizing public utility, the bill's backers, including our 43rd president, were able to significantly increase our budget deficit and national debt (by at least $400 billion in the first ten years of the plan's passing, according to recent estimates) while enriching large companies and compromising service for the ostensible targets of the legislation.
While expanding seniors' access to life-prolonging drugs is a noble goal in theory, without taking cost into effect, in its execution, Part D was horribly and deliberately flawed, most glaringly by the stipulation that the federal government not be allowed to negotiate with pharmaceutical companies in bulk for drug discounts, like the far more successful and cost-effective Veterans Affairs medical coverage.
The scandal surrounding the botched implementation of Medicare Part D, has ties to the Administration's record of corrupt political appointees, and the lobbyist orgy that was K Street. I'm no health care expert, and the full story has been told better than I could by several others, notably Paul Krugman at the New York Times. His article "The K Street Prescription" lays out the lobbyist ties of the main architects of the bill, and his earlier "Health Policy Malpractice" fills in the story of the Veterans Affairs model of health care and its superior ability to provide effective health care at a lower cost.
When you read this and other explorations of the Part D fiasco, don't forget the headline-grabbing tips of the iceberg. Don't forget Iraq and Afghanistan. Don't forget Katrina. Don't forget stem cell research, or the FCC, or our image in the world. Don't forget a thousand other abuses of the office, large and small. But remember Part D, because it's often the underwater part of the iceberg that sinks us.
-- Will Payne
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