The other day Tom Scully tried to defend his Frankenstein's Monster - the Bush Medicare Part D Drug Benefit - in a very interesting debate with Medicare Expert, Prof. Ted Marmor.

As many of you know, Tom Scully was Bush's Medicare chief as the former Administrator of the Center for Medicare and Medicaid Services (CMS) from 2001-2003 and one of the key figures in drafting the Medicare Prescription Drug Bill.  He actually received a waiver to negotiate his lobbying contract while still working on the Medicare reform law from inside the administration and is now the top healthcare lobbyist for Alston & Bird with clients such as Abbott Laboratories and Carmark.  He has been quoted saying that Medicare is "a dumb system" and "an unbelievable disaster," as well as calling for its privatization.The eloquent Ted Marmor is a professor of public policy, political science and law at Yale and is the author of The Politics of Medicare.  He is a part of the growing movement pushing to reform the prescription drug benefit to make it simpler and cheaper.

Surprisingly, Professor Marmor only briefly mentioned the scandal-ridden history of the program, instead focusing on how to change it now.  While it was probably the right thing for him to do in that particular setting, the temptation to blast Scully and his cronies for the obvious corrupt cronyism in the bills passage must have been hard for him to pass up!  I don't know if I could have resisted such a fertile attack opportunity.  But this decision did let him stay right on message on what changes are needed to the program, such as mandating price negotiation and having a Medicare run plan. 

Scully ended up agreeing that the handling of dual eligibles was absurd, but clung to his belief that that Traditional Medicare's single plan limits choice.  I think Marmor was right on to ridicule him on this point.  Traditional Medicare offers a wide choice of which caregiver to go to (the most important choice for most people), and limits the amount of confusion about what is covered.  And its just plain hypocritical when Republicans like Scully rave about the merits of choice, while at the same time blocking people from the choice of a standard prescription drug plan run by Medicare.  If people were given this option, the vast majority of the American public would choose a prescription drug program run similarly to traditional Medicare.      

But what I really loved and hope will be used by others was Marmor's description of the three sources of distortion in thinking about Medicare's Part D reform.  One group he called the "sinners", those who knew better but kept repeating that this was a good design, just some implementation problem. They were sinners because they distorted knowingly, lying really.  His second group was the "naive optimists," the ones who thought the administration was working hard and would straighten it all out, and despite the obviousness of the program's design flaws, it would all be worked out.  He described them as well-intentioned but silly. His 3rd group was described as "doctrinal", believers in market instruments no matter what the facts, but genuinely convinced that 'administered prices' are 'inefficient,' and such like.

Anyone want to comment on which category particular Republicans, and to be fair several Democrats, fall under?  It seems to me like President Bush has exhibitied a frightening amount of all three sources of distorted thinking, and not just in Medicare but other policies as well.  Is anyone else counting down the seconds until 2008?