"I voted against it, but once it passed I certainly determined that I would try to do everything I could to make sure that New Yorkers understood it, could access it, and make the best of it."

When Wisconsin Senator Kohl, the ranking Democrat on the Senate Select Committee on Aging asked his colleagues "to put aside any partisan thoughts to work together to get this program running," Democratic governors were already spending billions of dollars to help out.

As the Washington Post reported in January 2006, "Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving medicines." Roughly 6.4 million seniors who just days earlier had gotten their prescriptions for free faced the prospect of going without because of untrained pharmacists and computer glitches. By January 16th, 2006, the New York Times reported, many states (most of them led by Democrats) came to their rescue:



About 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program.

With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was previously taking, and it said that poor people must not be charged more than $5 for a covered drug.

Among the governors taking action were future Obamacare foes Tim Pawlenty and Mike Huckabee, who declared a health emergency in his state of Arkansas. The fiasco prompted the Bush administration to take drastic measures:It's no wonder why Paul Krugman summed up the whole catastrophe as " D for Debacle ."

The headlines in late 2005 and early 2006 tell the tale. The launch of the enrollment period for 43 million seniors to use their new drug benefit to purchase prescription coverage from private insurers was met with stories like "Medicare prescription drug plan stump seniors" (USA Today) and "Officials' pitch for drug plan meets skeptics" (New York Times). In mid-October 2005, Bush administration officials delayed the launch of their new prescription drug comparison web site for a few days, ostensibly to avoid offending Jewish Americans during Yom Kippur. Almost a month later, the site was still idle, prompting the Washington Post to conclude, "The rollout of the new Medicare drug benefit has been anything but smooth." Well into 2006, the Bush administration was dogged by stories like "Medicare drug plan still not generating much enthusiasm" and "majority of Americans say drug plan is not working" (Gallup).

But the very rocky start did not spell doom for the Medicare drug program. As Sarah Kliffof the Washington Post explained earlier this year, "Part D was less popular than Obamacare when it launched":



Eight years ago, the federal government rolled out Medicare Part D, a prescription drug benefit. For the first time ever, Medicare was launching a benefit administered exclusively through private health insurance plans. The benefit was not popular: In the spring of 2005, when enrollment efforts ramped up, polls showed Medicare Part D to be less popular than the Affordable Care Act. Fewer Americans felt they understood how it worked, too... Neither was especially popular in the months prior to their launch. Part D was even less liked: 21 percent of the public had a favorable opinion of the program in April 2005 compared to 35 percent in April 2013 for the Affordable Care Act.

A new poll sponsored by a health care group shows that 90% of seniors are satisfied with the program known as Medicare Part D, and approval has constantly risen since the plan came on line in 2006. "Nearly seven years later, 9 in 10 Medicare beneficiaries have prescription drug coverage," says the poll. "Satisfaction among those with Medicare Part D has grown 12 points from 78% to 90%. Most are very satisfied with their coverage and say their plan offers excellent value, reasonable costs, and convenience."

Past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset. However, the Medicare Part D experience teaches us that, when things went awry, federal and state officials were often able to identify problems and work with stakeholders to develop policy and operational solutions, so that consumers could obtain the promised benefits.

Part of the reason for Part D's rebound was simple. For tens of millions of American seniors, Part D was better than the alternative: nothing. As the Bush administration's bureaucratic bungles were ironed out over time (aided in large part by governors who stepped into provide resources, support and cash), public support increased. By October 2012, the Kaiser Family Foundation reported, "Survey finds seniors satisfied with Medicare Part D." As USA Today summed up the findings from Medicare Today last fall:In June, the reliably Republican Wall Street Journal also reported on the parallels between Medicare Part D then and Obamacare now. Reviewing an analysis by the Robert Wood Johnson Foundation ( RWJF ), the Journal explained:Alas, it is on that last point where the paths of Part D and Obamacare diverge. Unlike Democrats then, Republican officials at all level are trying to sabotage a health care reform designed to help millions of Americans. Rooting for its failure--precisely what was unthinkable for Democrats in 2005 and 2006--is now standard operating procedure for Republicans.