Where was the outrage over Medicare Part D?

March 26, 2010

Your March 24 editorial about the new health reform bill asks whether it is constitutional to require people to purchase health insurance ("Individual mandate is constitutional"). According to an article in the same issue of The Sun, 14 state attorneys general (all but one of whom are Republican) are filing federal lawsuits challenging the constitutionality of this requirement. Florida's Attorney General Bill McCollum, one of the 14, states that the new requirement "forces people to do something ... that simply the Constitution does not allow Congress to do." And one of your readers, Josh Dowlut, writes that "...never before has there been such an explicit requirement to buy such a specific product or service from a private, for-profit corporation. It is significantly unprecedented."

I wonder if Mr. Dowlut and the 14 attorneys general have ever heard of Medicare Part D. For those who have not, Part D was enacted by the Bush administration in 2003 and went into effect in January 2006. It requires all individuals who enroll for Medicare benefits to buy prescription insurance from private, for-profit insurance companies. Beginning at the time they enroll in Medicare, individuals who do not purchase a Part D insurance plan and who do not have other prescription insurance must pay a one-time penalty as well as increased monthly premiums once they do enroll in Part D. Where were the strident voices of the 14 attorneys general when Part D was enacted?

Unlike the new health reform mandate, the purpose of Part D was not to lower costs by spreading the risk to a larger pool of insured. We know this because the Bush administration did not negotiate with the pharmaceutical companies for lower drug costs before enacting Part D. The new health bill corrects some of the most serious flaws of Part D and includes several mechanisms for lowering the costs of health care for all Americans.

As your editorial points out, Social Security and Medicare are good examples of federal mandates that are comparable to the new health insurance requirement. Maybe Attorney General McCollum should find out how many of his constituents in Florida agree with him that these types of mandates are unconstitutional before he seeks the Republican nomination for governor in that state.

Bev Salehi, White Hall

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