All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D.

 

Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succinct piece called "Good Riddance to Karl Rove: How Part D Left An $8 Trillion Debt And Got Them Nothing," a genuinely damning indictment of the cynical use of power. Read Mr. Laszewski's posts and you quickly get the fact that he is a keen, unbiased, open-minded, analytical observer of the Washington health care scene. His obvious knowledge about the circumstances and his stature lend terrific weight to his words. I'd urge every person who reads this blog to read Mr. Laszewski's column, and to pass it around to your colleagues.

 

I was a distant observer of the Medicare D debacle, but close enough to know some of the key players behind the scenes, some of whom have moved onto greener pastures. (Among the most visible and loathsome was Rep Billy Tauzin (R-LA), who helped design and shepherd passage of the bill, and then, on the day he left Congress, assumed the leadership of the Pharmaceutical Research and Manufacturers of America (PhRMA).)

 

There were big winners all around: the Fortune firms who got a significant part of the largesse in the form of very rich retiree drug benefit subsidies; the drug companies, who got a new subsidized market at very high rates, and the health plans, who instantly had a new, very lucrative product, financed by Congress.

 

D is a program that is filled with holes, apparently by design, and that encourages outright abuse by less ethical health plans. If you doubt me, read this article on oral cancer drugs cost variation among D plans. Seniors who have the misfortune of choosing the wrong plan to be on when they discover they have cancer can have to pay the value of a house to get access to some drugs on the plan.

 

D was hugely irresponsible, expensive and deceptive public policy, designed for the industry rather than recipients and at extraordinary expense to taxpayers. As Mr. Laszewski points out, "Make no mistake, seniors deserve a drug benefit, but they deserve one that is part of a reformed Medicare system that is sustainable."

 

That is true, but its his closing line that is the sum and substance of why D was a pure act of worst kind of politics.

 

What’s the point of winning in the first place if you only use the platform to win the next one and leave $8 trillion in unfunded liability in the process?