As part of our ongoing blog series on Medicare Part D, The Catalyst caught up with former four-term Wisconsin Governor and former secretary of the Department of Health and Human Services Tommy Thompson.
The Catalyst: Governor, you were HHS Secretary when Medicare Part D was enacted by Congress in 2003. If you would, tell about your early experience with the program.
Thompson: My early experience is that the prescription drug benefit is working as we thought it would. Seniors are satisfied with the program. For the first time, seniors are getting meaningful prescription drug assistance. There was concern raised that there were too many choices, and seniors wouldn't be able to understand those choices. That concern is not playing out. Seniors are getting adequate information, and are able to make choices in their best interests. Just as we thought, acting in their best interests creates a market dynamic that keeps the program cost lower than what we even initially projected.
The Catalyst: Part D, obviously, was a the most significant change to Medicare since President Johnson signed it into law in 1965. What drove it?
Thompson: Throughout my life in public office, the number one complaint of seniors was the lack of a prescription drug benefit. Seniors could not afford to buy medication that would keep diseases in check and prevent them from expensive trips to the hospital. This problem was going to be exacerbated by the rapidly aging baby boomer population. We felt we had a chance to provide this benefit and to structure the program the right way. We thought it wasn't a partisan issue - we felt both Democrats and Republicans should support helping seniors pay for their medication.
The Catalyst: You've been a leading advocate of the need for a more coordinated and integrated health care system. What role will a program like Part D play in such a system 5 or 10 years from now?
Thompson: The problem with our health system is that it pays for "sick care." When you have a problem, you go in and get it fixed. The problem is that it is an expensive way of managing our health. We need to pay for wellness care - preventing the problem before it occurs. One important solution is to change the way we pay and incent providers, so that they are geared towards preventing illness. In that scenario, Part D can be an important part of the picture. Providers can diagnose problems earlier and help individuals change behaviors or prescribe prescription medication that can help manage the problem. Before, a doctor couldn't be sure a senior could pay for that medication. Part D helps to solve this problem.
The Catalyst: HHS Secretary Sebelius and CMS Administrator Berwick recently announced that Part D premiums will come in lower in 2012 compared to 2011. Given this and the year-over-year budget performance, is it fair to say that the Part D debate is over?
Thompson: The selling point to me of the prescription drug benefit was meeting the needs of seniors through an environment that used market forces to keep the program from becoming too expensive. You are always going to see policymakers want to make adjustments to the program, but major adjustments could disrupt the market and increase costs. In this fiscal environment, why would you take A program that is working to push down prices and risk decreasing its effectiveness? Rather than change Part D, I would apply the lessons learned to other aspects of the Medicare program.
The Catalyst: How do you feel that the program can be improved?
Thompson: I'm satisfied that it is working well. I don't see the need for major adjustments.
The Catalyst: Anything we're missing?
Thompson: I think the real focus for improving the Medicare program and creating its fiscal stability relates to getting the provider incentives in the right place. I am hopeful that the new Supercommittee will take a close look at that.