The New York Times started a small brush-fire this weekend with an article saying that not everyone’s losing out because of Part D. They even found some people who were gaining from it. Now much of the article went into detail about the continuing problems, but of course those in favor of Part D (basically AHIP) were all over the story called “for some who solve puzzle, Part D pays off” — as though those of us broadly opposed to Part D (or at least the way the law currently stands) were saying that everyone would be suffering. Over at The Health Care Blog I essentially show that sober observers had pointed out back in 2004 that some people (the low income folks who use lots of drugs) would be better off under the law as enacted. But my conclusion is that the politics of the story are still very negative for Bush and the Republicans.

Independent of the implementation screw-ups which CMA deputy administrator Leslie Norwalk says are no surprise and temporary, two-thirds of the Medicare population is worse or no better off because of the new law. Joe Paduda also notes that the low enrollment in Part D will lead to adverse selection and thinks that they’re going to have to delay the premium increases coming in May in order to encourage more entries from those on the fence. Of course a compulsory program would be better, but we wonks who understand risk pools don’t have much influence.

But while Part D is the biggest and most flawed part of the whole bill, there were plenty of other goodies in the bill. For a start it delays the eventual price control monopsony that Ezra may not think is coming, but will come eventually (when we sort out the whole health care mess) until well after the current crop of Big Pharma CEOs are retired. Second, it gives a huge boost to the payments going to Medicare Advantage plans (the Medicare managed care programs run by private, usually for-profit insurers). You can spin that anyway you like, but those are both transfers of wealth from taxpayers to private corporations, in keeping with the rest of the Administration's actions over the past 5 years.

So despite the partial successes that the NY Times found, and the slight increase in enrollment numbers that Kate talked about, Part D is still a disaster for the Republicans. It's also a disaster that really matters for a core voting group (seniors) who vote almost exclusively about health care, and who are more than proportionally important in America’s two “oldest” states (Florida and Pennsylvania) where this November there are Senate races that really matter. And if Medicare Part D is eventually responsible for kicking Rick Santorum and Katherine Harris out of Congress, then maybe the whole thing will have been worth it!