It makes perfect sense. And, there are probably dozens or perhaps even hundreds of other medications that keep small medical problems from growing into more pronounced problems that require more costly types of intervention.

My two biggest problems with Part D is that we didn't pay for it, and we handcuffed these federal agencies from being able to negotiate the prices of these medications. Sadly, you can lay blame for these two elements largely at the feet of the GOP. Intentional deficit spending of more than $75B annually as well as purposeful government waste, aren't very conservative principles.

Having said that, without Medicare Part D enactment, it's likely that the Democrats would have had their issue to drive a wedge between the GOP and Seniors. Considering that Seniors are the single most reliable GOP demographic, without their overwhelming support, it's also likely Bush doesn't win reelection, and the GOP loses one or both houses of Congress two years earlier. Then, we would have been stuck with something even worse than Part D. The political reality is old people want free stuff; they think they're entitled to it because they've (somehow) already paid for it. Since they're such a well-organized demo, they generally get what they want.

"The research on preventive testing and medication is ample and consistent on this fact."

That's true. But, it's also true that(with Medicare Part D) we're treating hundreds (thousands?) of different diseases that while chronic, may not worsen over time. IOW, the disease may have quality of life implication, those implication - while unpleasant - may not worsen to an extent that will eventually require hospitalization or other more costly intervention. The drugs for those kinds of diseases are plentiful, and they're expensive. Anti-depressants and other psychological medications come to mind immediately. You can live with "restless leg syndrome" without ever being hospitalized for it. So, if Medicare starts paying for your RLS medication, there's no cost-savings upside for Medicare as that medication isn't going to prevent a more costly intervention in the future.

In Newt's example of Lipitor, or other medical management drugs - like blood pressure medications, the preventative effect can be profound. He's right: Lipitor over 25-years is still less expensive than triple-bypass surgery - which may even need to be repeated in 25-years without the cholesterol lowering medication.

It seems to me that while Medicare Part D did have long-term cost-saving potential for Medicare, Congress should have been much more discriminating with respect to the kinds of medication that was covered.

But, as I said, old people love free stuff, and they wanted all their medication covered. As a practical political reality, it was going to happen sooner or later - and by later, I mean a couple years later, not decades later. The AARP isn't the most powerful lobby by accident.

Gingrich is a disaster. The last thing the GOP needs is a nominee whose last 12 years have been devoted to lobbying for expansions to Medicare (Part D as noted here, attacking the Ryan Medicare reform plan, etc.), "alternative energy" subsidies, and government subsidies (in the form of cheap loans) for people to buy homes they can't afford.

Three of our biggest problems, and Gingrich has lobbied for them all. You can't make this stuff up.

Bashing Mr. Gingrich for supporting Part D is just dumb. Unlike most private plans, Medicare lacked substantial outpatient drug coverage prior to Part D. It was still stuck in the 1960s when hospitals were the apex of medical care. This antiquated structure led to absolutely stupid things like paying for hospitalization so people could afford drug treatment. It was high time Medicare moved into the modern era. And unlike the rest of Medicare, Part D was organized to operate without price controls.

The real question is whether Mr. Gingrich is now willing to extend the Part D success to the rest of Medicare and move it towards being a premium subsidy program as Ryan envisions.