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Comment by refurb | Hacker News Reader

The only time the welfare state in the US has actually gotten smaller was Clinton's welfare reform in the 1990's. That was easily offset by things like Medicare Part D in the 2000's.

People keep talking about "stripping away the safety net", but when I look at entitlement spending, it just keeps getting bigger.

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clinton's slashing of the welfare state is a matter of degree, not the only instance of purported beneficiaries losing benefits. medicare part d doesn't allow the government to negotiate prices and thus functions more as a subsidy for the pharmaceutical industry than people for whom it is ostensibly intended to prescription access. lots of games can be played with budgets (such as block grants, one notorious example being the 1981 repeal of the mental health systems act) so the raw dollars of entitlement spending can grow without representing a true shift in resources. when cost of living (eg rents, healthcare) outpaces spending, all while units of public housing are destroyed without being replaced, and the terms of occupation have grown ever more stringent (for example, requiring maintenance come out of tenants' rent while lowering the maximum eligible income for tenants), the mere dollar amount of spending becomes a less definitive measure, i think.

medicare part d doesn't allow the government to negotiate prices

The gov't can't negotiate prices, but the private insurers who manage Part D plans absolutely can.

and what effect has that had on drug prices in the us compared to other countries?

Actually, the Part D plans have been able to get better prices than commercial payers.

So I'd say it worked pretty well.

ok, i think you're being intentionally obtuse here. thanks for your time.

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