Obamacare and Prescription Drugs

by Ramesh Ponnuru

Over at National Journal, Lucia Graves rejects my comparison of Obamacare to the Iraq War and instead compares it to the Bush administration’s launch of the prescription drug program for Medicare. First, though, she says that my comparison is “not an original thought.” Fair enough — never claimed otherwise. Neither, of course, is the prescription-drug comparison original. Which is why I was able to prebut Graves a few weeks ago:

In recent weeks, proponents of Obamacare have been arguing that we shouldn’t make too much of its early troubles, because President George W. Bush’s prescription-drug program saw early fumbles, too. (The people behind Obamacare may not be good at building websites, but they’re great at manufacturing excuses.) It’s perverse, of course, to suggest that the difficulties of a smaller, far less complex program are a good omen for Obamacare. But the bigger problem is that Obamacare is vulnerable to adverse selection in a way that Bush’s program was not.

Medicare Part D, as Bush’s program is called, supplemented the coverage people already got from the federal government. The government knew who they were and where they were. It was offering them a straightforward benefit. And it didn’t much care whether the people who signed up were healthy or sick. Whether to buy an insurance policy on Obamacare’s exchanges is, by contrast, a decision with pros and cons, and exactly who decides to sign up matters a great deal to the program’s functioning.