One thing that has been eating away at me throughout this whole health care debate is the incredible hypocrisy and role reversal of both political parties compared to the Medicare Part D debate. The basic, highly corrupt design of the Senate health care bill is the same as the highly corrupt design as the Medicare Part D program.

Just think about the similarities. Both were meant to address serious problems—for the Medicare drug program, seniors unable to afford life-saving medication, and, with today’s legislation, people unable to afford health insurance. And, in both cases, instead of solving the problem in the cheapest, most direct way by having Medicare just provide these groups with what they need, a wasteful, convoluted, “market” system was created to use the program to enrich industry players and unneeded middlemen.

Medicare Part D

In Medicare Part D, seniors must select a private health insurance plan on an exchange to provide them with prescription drug coverage. This allows the drug makers to get away with charging higher prices than if the government directly negotiated for the medications, and enriches completely unnecessary private health insurance middlemen. The system heavily subsidizes both industries in this wasteful structure, costing taxpayer’s billions.

The marketplace is poorly regulated, and the choice of plans is incredibly confusing. The bill did not allow for proven cost-savers like drug re-importation or a “public alternative” by having Medicare directly negotiate for drug prices.

The Senate health care bill

In today’s Senate bill, regular people will be forced to select a private health insurance plan on poorly regulated exchanges with a confusing array of packages. This will allow care providers, hospitals, and drug makers to get away with charging much higher prices than if the government directly provided the insurance through Medicare, and enriches completely unnecessary private health insurance middlemen. The system will heavily subsidize the health care industries in this incredibly wasteful structure, costing taxpayer’s hundreds of billions of dollars.

Don’t forget Billy Tauzin

One of the biggest complaints Democrats had about Medicare Part D was the influence then Republican Rep. Billy Tauzin had in writing the bill. He worked with the drug lobby (PhRMA) to make sure the bill existed primarily as a massive giveaway the drug industry by keeping out drug re-importation and Medicare direct drug price negotiations. The lack of these two provisions until recently were the two big complaints Democrats had about Medicare part D, and a big part of why almost every Democrat said they voted against the bil. The promise to fix these two problems featured prominently in Barack Obama’s presidential campaign.

Guess what? Billy Tauzin, this time in his role as head lobbyist for PhRMA, had a huge role in writing this Senate health care bill. He again assured the bill would be a massive giveaway to drug companies by cutting a secret, backroom deal with Obama to keep out drug re-importation and direct Medicare price negotiation. In addition, this time, Tauzin also won another big giveaway to the brand name drug makers by securing an extremely long exclusivity period for biologic drugs.

So similar, the two programs could be twins

If there is a real policy or ideological difference between the design of the two programs, I fail to see it. Both use corrupt, poorly designed exchanges (which have been proven to not control costs) that make people choose only among a small assortment of wasteful, private health insurance policies. Both programs would actually do some small amount of social good (help some senior citizens afford medication then, and help some regular Americans afford insurance now), but at the huge cost of using a shockingly wasteful setup, which will cost taxpayers and participants something like 20-60% more than it should if done with a simple, straightforward public program. Both programs also just further enrich, empower, and entrench the private health insurance industry, making real reform even harder in the future.

What I don’t understand is how so much of the media will let Republicans pretend to have some ideological problem with a health care bill of basically the same design as the Medicare Part D setup that they created. What I also can’t understand is how “liberal” organizations can now tell Democrats in Congress that they must vote for a health care bill that contains all the same terribly corrupt problems they rallied against when they tried to take down Medicare Part D.

Why was it great when progressives in Congress voted against Medicare Part D, but they are now being called monsters for objecting to the Senate health care bill on the exact same policy grounds? I suspect this sort of inconsistency plays a large part in the cynicism most American’s feel with regards to Congress and national governance, in general.