Making Social Welfare Policy in America: Three Case Studies Since 1950 by Edward D. Berkowitz

Author:Edward D. Berkowitz [Berkowitz, Edward D.]
Language: eng
Format: epub
Tags: Public Policy, United States, Social Services & Welfare, Social Policy, 20th Century, Political Science, History, General
ISBN: 9780226692234
Google: 8M3XDwAAQBAJ
Goodreads: 49414929
Publisher: University of Chicago Press
Published: 2020-04-15T10:59:48+00:00

Prescription Drugs: Preliminary Battles

Adding Part C to the program took more than thirty years. Because of the partisan battles that appeared to be a distinguishing feature of late twentieth- and early twenty-first-century politics, one might have expected a similarly long wait for Part D. As it happened, Medicare Part D arrived in 2003, only six years behind Part C. Products of the same era in Medicare policy, the two new parts of Medicare resembled one another in their reliance on the private sector to deliver benefits (although with federal money) and on market competition to control costs (although with federal regulation). One could regard Part D as another legacy of the Gingrich revolution, even though it was passed after Gingrich had left Congress.

Part D concerned prescription drugs, which had been a preoccupation of Medicare administrators since the program’s creation. In 1965, during the passage of Medicare, participants in the political debate recognized the importance of prescription drugs but regarded insurance against the cost of hospital stays as a higher priority. Almost as soon as Medicare was passed, however, calls rose to expand the program to include prescription drugs. The first things that influential Social Security Commissioner Robert Ball put on the incremental expansion list in 1969 were health care benefits for people on the Social Security disability program, which was soon achieved, and prescription drug coverage, not achieved until the next century.61

From the program’s very beginnings, Part A covered the cost of prescription drugs that Medicare patients received in the hospital. During a hospital stay, it was almost routine for a patient to be taking a prescription drug after surgery or some other event. If a patient was already taking prescription drugs at home, the hospital, as directed by the treating doctor, supplied those he or she still needed to take in the hospital. When the person got home from a hospital or rehabilitation facility, however, he was largely on his own—dependent on his own funds or his private insurance coverage to pay for drugs. Even then there were exceptions to this general rule. Patients being treated for end stage renal disease often became anemic, and the drug to treat that condition was reimbursable by Medicare. During the AIDS epidemic, immunosuppressive drugs were added to the list. If a drug needed to be administered in a doctor’s office or if its cost or efficacy came to the attention of an interested congressman, it had a chance of being added to the list of physician-dispensed drugs. By 2001 the program reimbursed 454 of these drugs.

These incremental and stop-gap methods failed to solve the general problem of making sure that Medicare beneficiaries could afford prescription drugs. As early as 1967, President Johnson asked HEW Secretary John Gardner to convene a task force on prescription drugs, headed by Assistant Secretary for Health Philip Lee, an important advocate of increased government financing for health care. Johnson might have proposed the task force as something of a delaying tactic, as the many parts of Medicare still needed to be implemented and the initial costs of the program exceeded expectations.

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