案例库 · 战略与领导 · 战略决策 · 2003–2006
这条还没译成中文，下面是英文原文。
Medicare let private insurers bid for the drug subsidy instead of setting prices.
Part D set premiums from insurer bids: CMS averages the bids, pays most of the cost, and lets competition, not government price-setting, contain drug spending.
Centers for Medicare & Medicaid Services · U.S. Congress
那一手
Before 2006, Medicare covered no outpatient prescription drugs, and seniors bought coverage in a thin private market with high premiums. When Congress designed a drug benefit in the 2003 Medicare Modernization Act, the obvious options, government price controls or a public formulary, collided with political and administrative realities.
The mechanism chosen was bidding. Private plans submit annual bids for a standardized Part D benefit; CMS computes a national average monthly bid and sets a base beneficiary premium from it; enrollees pick among plans and pay that plan's premium. The government never sets drug prices, each year's bids determine what seniors pay.
It worked as a price-discovery machine: the 2006 base premium was $32.20 against a national average bid of $92.30, and the 2007 premium fell to $27.35 as bids came in lower. Two decades later the same bid-based framework remains in place, with the 2026 base premium at $38.99.
为什么管用
- Annual bidding turns every plan into a standing price-discovery mechanism.
- The base premium is computed from bids, not negotiated, so subsidy costs track the market.
- Beneficiary choice among plans turns premium differences into competitive discipline.
- The design survived intact for twenty years, which few government pricing schemes can claim.
可以搬走什么
If you must subsidize a private market, do not set the price: collect bids, pay a fixed share of the average, and let each supplier's own bid determine what users pay.
后来呢
Part D grew into the largest federal drug program, and the bid-based structure still sets premiums today, though the Inflation Reduction Act added negotiated prices for a first set of drugs in 2026. Critics point to benefit complexity and plan-choice overload, but the core idea, let insurers bid and derive the subsidy from the average bid, has proven durable.
资料来源
- Status Report on Part D — online appendix: base beneficiary premium and national average monthly bid, 2006–2010
- Evaluation of the Medicare Demonstration to Limit Annual Changes in Part D Premiums
- A Current Snapshot of the Medicare Part D Prescription Drug Benefit
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