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Comment by dc-programmer | Hacker News Reader

This is true. But fatal flaws such as the fact that Medicare cannot negotiate prices with drug companies are not accidents but rather artifacts of corporate lobbying. There are many examples of rent seeking like this across the system

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Medicare didn't cover drugs at all until 2003 when Bush put together Medicare Part D to bolster flagging support. Medicaid doesn't negotiate prices either, but it's mandate that it will pay the lowest negotiated price in the market. When Part D was passed it almost had a similar structure. In 2016 there was a move to add negotiation but it fizzled. In both cases the CBO estimated that negotiating prices would save precisely no money. The way Medicare plans actually work is that plan provider bid to be part of the program and they are selected on a cost basis, and they then negotiate drug prices. Could Medicare administrators do a better job? Well the CBO has twice said no. Medicare Part D was a huge hack to cover a made up problem, which is to say seniors too wealthy for Medicaid not being able to afford their heart medicine. It was essentially GWB trying to buy voted before the 2004 election. So I think you're wrong on the history here.

Who do you think cane up with and wrote his domestic policies? That’s literally what lobbyist are for. They have these things drafted up ready to go years in advance (just like the Heritage foundation and SC picks). The only thing that might be last minute is the decision to go with it.

They know exactly what the downstream effects of these programs will be. Regulatory capture is a well attested phenomenon, so I’m skeptical of any claims that all the Byzantine policies that just so happen to favor big business came about haphazardly

Bill Frist wrote most of the legislation that became Medicare Part D, he was old buddies with Rove. Frist was a hospital guy and a bit of a scammer before going to congress, I won’t deny that he was in the tank for hospitals, but the pharma lobby didn’t write his law. The original version was pretty modest, people criticized it at the time for not spending enough money, though it may now bankrupt Medicare. I remember it pretty well because I was just then getting interested in politics, but a ton has been written about it.

I guessed and was basically directionally correct. That guy seems like he fits the Bush mold - Cheney and Rumsfield privatizing huge parts of the military comes to mind. Don’t get me wrong what you are saying makes sense. I’d be more surprised if it were a coherent system.

But I do believe many government regulations and laws that may seem like sphaghetti against the wall at first are actually very intentional and lucrative to someone.

We’ll this thing in particular was Frist’s pet project for years, Bush and Rumsfeld just needed seniors on board for the election so it finally got done.

A lot of things happen that way, just horse trading and trying to get re-elected.

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