First, Do No Harm: Leave Medicare D Alone

“First, do no harm” has served as a guiding principle for health care professionals since ancient times. It’s a phrase that acknowledges the limits of even modern medicine: There’s a lot we don’t understand, and doing nothing is the often the best course of treatment.

The principle of “first, do no harm” is one to keep in mind as the Obama administration considers tinkering with Medicare Part D, the prescription drug benefit for seniors added by the Bush administration. As part of the left’s endless “Mediscare” campaign in which keeping seniors nervous is considered good politics, the Obama administration is talking about placing price controls on prescription drug benefits through Medicare Part D. They’ve basically taken a hostage as part of the ongoing deficit reduction talks.

Medicare Part D is that rarest of government programs: One that has worked better than expected and cost less than expected. Prescription drugs are provided by private insurance plans that compete for customers among enrollees. The profit motive encourages the use of generic drugs instead of name brands, for example, a simple but huge step to hundreds of billions in savings. Free-market conservatives argued that introducing consumer-driven, market based competition to this one aspect of health care would lower costs compared to government-run benefit programs. They’ve been proven right in the five years since Medicare Part D went into effect. Total program costs are about 40 percent lower than forecasted, costs have increased at a slower rate than expected, and consumers report high satisfaction rates in the 90s.

But the politicians are having trouble leaving well enough alone. The proposed price controls would make the program operate more like Medicaid, the welfare health care program for the poor. Not only is Medicaid bankrupting states, but low reimbursement rates are causing more and more medical professionals to decline to treat Medicaid patients. This, in turn, creates access issues for patients who need care. Making Medicare more like Medicaid is not the direction to move in.

I’ve long argued that Republicans and conservatives need positive health care policies that address the real needs of our loved ones and neighbors. The Republican health care plan can’t be, “Don’t get hurt and don’t get sick.” The Medicare program, like all government entitlement programs, needs modernization and reform to ensure it doesn’t run out of money and we can afford it. But tinkering with Part D, the part that works the best just five years after it was begun, is the last place government should begin.

Fergus Cullen can be reached at

Author: Fergus Cullen

Fergus Cullen is a former chairman of the New Hampshire Republican Party (2007-2008) and an editorial page columnist for the New Hampshire Union Leader.

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