Eight years ago, the government opened enrollment in Medicare Part D, the prescription drug benefit. I remember talking to people involved in the rollout, and it sounded terribly confusing. I could easily imagine how confused elderly people might be by its competing plans. I remember no one had a clue how expensive it would be. The White House had prevented one pencil-pusher from testifying before Congress, as I recall, because his cost estimates were far higher than the administration’s talking points. It squeaked through Congress on a close vote, with Dick Armey twisting arms and stopping the House vote clock and Billy Tauzin earning his job with Big Pharma by handing out bribes on the House floor.
This is not promising, I remember thinking.
But people worked together to get the word out: doctors, Medicare and Social Security administrators, Councils on Aging, pharmacies, drug companies. They helped Medicare beneficiaries understand the options and figure out the best deal for them. It helped that even those who opposed the bill didn’t try to undermine it at every turn. No political group put commercials on TV telling seniors to boycott Medicare Part D. No governors refused to help. No state passed a law prohibiting its employees – or anyone else – from helping Medicare beneficiaries understand the program. No one characterized it as the mark of Satan or the cassus belli for a new American revolution.
Medicare Part D has proved to be popular. It’s not seen as a disaster, the ruination of the health care system or the economy. They made it work, which is one reason I take with a grain of salt all the hysteria about what a terrible, horrible disaster the Affordable Care Act is. People acting in good faith can make this law work. It can help millions of people who have serious health and health insurance problems.
My guess, though, is that the success of ACA implementation will vary from state to state. It will work a whole lot more smoothly in states with governors who want it to work.