Medicare Part D Quotes

Well, this was predictable. House Republicans last week acceded to an extension of the Export-Import Bank for at least the next nine months. The Export-Import Bank is far from the worst example of government-business cronyism. I just completed a history of American political corruption and actually had to leave Ex-Im on the cutting room floor. Its cronies are pikers compared with the corporate moguls that take advantage of tax preferences like the G.E. and Apple loopholes. They also cannot hold a candle to the American Medical Association, which is basically free to write the reimbursement rates for Medicare Part B. And nothing compares to Fannie Mae and Freddie Mac from 1991-2008. The two mortgage giants kept the entire D.C. political class bent over a barrel for almost 20 years as its top executives reaped enormous bonuses while putting the broader economy at risk.

Obama was far more conservative than Richard Nixon, for example, and this has been the Democratic story since Boomers started voting en masse. The initial deregulatory impulse began under Carter, not Reagan; it was Clinton, not Bush I, who promised to “end welfare as we know it” and declared that the “era of big government is over”; it was Obama who made most of the Bush tax cuts permanent, and so on. But there have also been some odd spectacles on the Right: the provision of prescription drug benefits to seniors under Bush II (Medicare Part D; apparently the era of big government was not quite over), and substantial increases to Medicare and Social Security taxes under Reagan and that president’s decidedly statist salvation of the savings and loan industry. What accounts for these odd paradoxes? Shouldn’t Bush II have been the one taking an ax to welfare and Clinton been pushing Medicare Part D?

It’s also true that today’s state of affairs is far, far better than it was before passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, which created Medicare’s Part D drug plans. Prior to that law, many seniors could not afford drugs and either skimped on prescriptions or simply went without medications.

Now, Part D plans often market themselves based on their annual out-of-pocket limits on your drug expenses. Ceilings differ by plan and can be a major factor in choosing a plan in the first place. But these ceilings do not protect you from those 5 percent charges.

The insurers who run Part D plans don’t like high drug prices, either. Even though their cost exposure is only 15 percent—remember, you pay 5 percent at most and Uncle Sam pays 80 percent—they would like it to be 15 percent of the smallest number possible. And it’s not Big Pharma that takes the calls and emails from unhappy Part D customers.

If you are a wealthier taxpayer, you get a double Medicare hit. You pay more in Medicare payroll taxes because you earn more (recall that, unlike Social Security, there is no wage ceiling on Medicare taxes). But you also pay more in Medicare Part B and Part D premiums, and this enforced tithing will get worse, beginning in 2018.

Part D plans are voluntary per Medicare rules, which strikes me as a really bad idea. Who except the 1 percenters can afford to pay for their own meds? Yet while Medicare is telling people they are not legally required to have Part D plans, it will sock them with potentially enormous penalties should they fail to enroll in the plans when they first take Medicare.

Table 5.2 Retiring before 70 Means Much Lower Benefits “Net” Replacement Rate for Medium Worker by Retirement Age, 1980–2030 Note: Year is date retiree reaches age 65. Replacement rate is net of Part B and D premiums, as well as taxation of benefits. Part B SMI deduction for 2030 assumes SMI continues to cover 26 percent of plan costs and uses Trustees’ Report enrollment and cost growth assumptions. The assumptions are that the beneficiary has enough other income to have benefits taxed (about $10,000 in 2030) and that the tax rate is 12.5 percent. Sources: Authors’ calculations based on Centers for Medicare and Medicaid Services (2013); and Social Security Administration (2013b).