Disruptive Proposals May Undermine Medicare Part D’s Success

Health care policy has unfortunately become a partisan weapon these days, fueling reactionary ideas while overlooking the needs of patients for the next political soundbite. 

Gone are the days of good-faith negotiations across the aisle, replaced by inconsistent policymaking that should have no place in how we approach critical programs like Medicare Part D. That doesn’t mean we can’t modernize and improve the program, but with all the ills of our health care system that desperately need addressing, why on earth would we make harmful policy changes to a proven program?

A troublesome proposal currently being discussed involves government arbitration within Part D. With this type of system, the government would select a panel to decide the price of a drug. If an agreeable price is not assigned, it is entirely possible that the manufacturer could reduce or stop production of that drug, causing seniors to lose access to many of the prescription drugs they currently rely on — particularly the more modern, innovative treatments approved in recent years.

If this sounds familiar, it’s because it bears a striking resemblance to the Independent Payment Advisory Board instituted under the Affordable Care Act. Like these potential arbitrators, IPAB was a board appointed by government officials charged with making health care decisions with no required understanding of how their changes may affect patients. 

While perhaps well-intentioned, IPAB proved deeply unpopular with voters in 2010, devastating Democrats at the ballot box. IPAB was eventually repealed after years of pressure, and I doubt voters have warmed to the idea in the intervening years.

Despite the outcry over past harmful proposals, we continue to take the Medicare Part D prescription drug program for granted. 

Long forgotten are the stories about seniors choosing between groceries and medicines. Long forgotten are the legislative battles over how to — or even whether — we should cover prescription drugs in Medicare. And, sadly, long forgotten is the idea that governing from the center and allowing private negotiations to guide the marketplace is the reason for the remarkable success of Part D over the past 15 years.

During my time in both the House of Representatives and the Senate, we spent much too long debating whether we should either add a prescription drug benefit to a fully government-run program or completely privatize coverage. After years of asking the wrong questions, Congress finally realized that neither approach was the right one, and the answer lie in the middle.

Ultimately, when designing Part D, we took the best of what the government can do and the best of what the private sector can do, and guess who the winner was: seniors. Beneficiaries are afforded access and protections through government oversight while also taking advantage of choice and innovations from a competitive private-sector delivery system.

Today we barely pause to marvel at Medicare Part D’s achievement. The program has come in more than 40 percent under budget, while remaining incredibly popular with enrollees.  

Seniors enrolled in Part D enjoy significant choice in plans, including many tailored to specific needs or lifestyles, and they’ve more than risen to the task as informed consumers, helping drive down costs via competition. Because competition is raising productivity and helping control costs, Part D premiums are surprisingly low, and some years they even go down.

Balancing the incentives of hospitals, doctors, drug companies and patients to harness the power of the market is a tough nut to crack and all too rare in health care. So why rehash history now?

It is okay to consider smart policy approaches that can lower health care costs for beneficiaries. But any changes to Part D must honor the spirit in which the program was created, or we would be doing a disservice to our seniors who depend on this program. 

Congress should think about what changes would make the program actually work better for beneficiaries. There is currently a lot of talk about out-of-pocket costs to consumers in the health care system today, so that would seem like a good place to start. Rethinking the catastrophic coverage cost-sharing in Part D seems like a very worthwhile policy idea.

Working with my colleagues to create Part D was one of my proudest accomplishments in the Senate. It may not have been perfect, but we harnessed the best of what each stakeholder offers and proved to today’s policymakers that, done the right way, competition can contain costs without sacrificing quality and beneficiary satisfaction.

It is increasingly rare in Washington for things to align the way they did for the creation of the Part D program. Medicare Part D is popular and sustainable, and its history must be a guide to any changes to ensure that Part D’s next 15 years are as successful as its first.


Former Sen. Blanche Lincoln served 16 years in the U.S. Congress — first as a two-term member of the House of Representatives and then as a two-term member of the U.S. Senate representing Arkansas.

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