Would the Democrats have created Medicare part D?

[Sbane]

However, if Al Gore had power, then yes they would have created Part D.  However, Gore wouldn't have cut taxes and not pay for it.

This. The worst part about Medicare part D was not paying for it. Of course we can also argue about the merits of it, but what's really f'ed up is not paying for it and then blaming others when they try to clean up your mess. Sort of like the wars too. Who the hell cuts taxes when they go to war? It's so f'ed up that it's just funny now.

[Sbane]

The main critique of the program is how the law forbids the government to negotiate prices. This means the Part D program pays much more than other federal agencies (like Veterans Affairs) for the same drugs.

was hoping someone would bring this up.  such a provision is literally unparalleled in the whole history of the world; as Chomsky puts it, the Pentagon negotiates prices when it buys paperclips.

Not exactly the same. There are no intellectual copyrights on paperclips -
To negotiate prices there has to be a credible risk for the buyer to walk away. So you have to recognize by doing that you are risking not having newer drugs available to those on Medicaid.

Good point, but you can still negotiate prices if you buy in bulk. And if you are paying full retail, then why not just order it on a case by case basis (ok maybe I am dreaming that a beauracracy will be capable of this) if needed. In the meantime use a tiered basis for giving out drugs, with the cheaper, generic versions being preferred first. And then on the basis of efficacy you can move on to brand name or other options. This is what hospital systems do.