What Government Does(n’t)

Interesting. Ronni Bennet posts an account of her interactions with Medicare Part D, on Time Goes By. The majority of her post is about dealing with her private insurance company, who can’t seem to get their act together. A commenter says “I have had similar experiences helping the elderly as well as myself. Anyone who thinks ANY program should be run by the government is delusional.”

I am one of the first people to admit that the Centers for Medicare and Medicaid Services (CMS), the federal government entity administering Part D, has not done particularly well. Ask anyone who’s been at a party with me in the last six months – I have LOTS of information to share on that topic.

But I found it funny that in this instance, poor performance of the private sector was blamed on the government. Unless the commenter meant Congress, which designed the program explicitly to be delivered by private companies. (Obviously the commenter was also reacting to past experiences with public programs as well; I am not trying to dismiss her observation.) The private companies get their money and their data from the federal government, but they are actually the ones “running” the program in terms of enrolling people, establishing their benefits, and paying claims to pharmacies.

The public policy geek in me does wonder how much accountability the government has for ensuring the Part D insurance companies deliver the services they are being paid for, and what tools the government has at its disposal to enforce that service delivery.