We here in the first decade of the 21st century have been privy to a sudden revolution in the federal system, made evident again the past two weeks in the catastrophe that is the government’s new Medicare drug program.
A premise of the great expansion of the federal government after World War II was the general incompetence of state governments to deal with social and economic upheaval. The government that built Social Security and ran the most idealistic and successful war and postwar efforts in history was called upon to end racial segregation across the breadth of the land, secure voting rights for a disfranchised people and build a system of health security for the elderly, disabled and poor.
Now the national government is so inept that it can do nothing expertly or seamlessly.
Its giant intelligence apparatus could not provide enough simple knowledge about a decimated society to keep an eager administration from leading the nation into a destructive war, the government launched a fiscal policy that took the country overnight from vast surpluses to the most humongous budget deficits in history, and the nation awoke last fall to see its national government flounder helplessly in even getting ice to the desperate people of the Gulf Coast because the administration’s corrupt political managers had dismantled its great emergency management program.
Last week, we were treated to the spectacle of Gov. Huckabee deploying the state government to bail out a bewildered and helpless Washington, which was shocked to discover that it had inadvertently cut off life-saving medicine to hundreds of thousands of the most vulnerable elderly people in the country. Like governors in most states, Huckabee directed his state health agency to pay for the prescriptions of former Medicaid patients who could not get them when the new Medicare law went into effect Jan. 1.
When Congress passed the changes, it expected simply to switch people from Medicaid to Medicare, shifting the costs from one account to another, a gesture that was to mollify states by saving them matching funds.
Arkansas cannot bail the administration out for long because it cannot borrow money.
Huckabee says he is promised quick reimbursement by the Bush administration once they get the mess straightened out. Having had some experience with this administration the last six months, Huckabee must have troubled sleep. The governor is on shaky ground legally in authorizing the state expenditure, but it is what a caring and efficient government does. Thank you, Mr. Huckabee.
The administration had three years to implement the plan. It had become clear early last year that neither Congress nor the administration that wrote and implemented the plan knew what they were doing. Efforts were made in 2003 when Congress was debating the plan to fix it to protect the aged poor, but the administration said no. Not needed, it said. Last year, Senate Democrats introduced a bill to delay the transition to Medicare for six months to work out the kinks so that the elderly poor might have continuous drug coverage. Spurred by the White House, every Republican voted no.
Simple incompetence is not all that is at work in this disaster.
When Karl Rove advised President Bush that it would be expedient to counter the Democrats’ appeal by co-opting the idea of insuring medicine for the elderly, the administration decided that if needy citizens were to be helped, the big corporations that had been so helpful in election season ought to be cut in on the billions. So instead of a simple expansion of Medicare coverage to prescription drugs, the administration established an elaborate program that had huge gaps for the elderly and required them to purchase the government coverage through commercial health-insurance companies, which would administer the program for the government in ways that would maximize profits.
The Bush administration even by the first week of the program was making changes itself to thwart the elderly sick. The now famous “doughnut hole,” which created a huge gap in coverage for every senior regardless of their financial condition, was not enough perversity. For example, heart patients whose only help was a drug called Niaspan, which raised levels of good cholesterol, learned from their druggist that the government had told the insurance companies not to pay for patients’ Niaspan even if it was covered in their formularies. Heart-disease sufferers could pick a less effective drug or else pay for it themselves.
Huckabee expects his friends in Washington to fix Medicare and do the right thing next week. Good luck, governor!
