Uwe E. Reinhardt points out that in 2003, no one subjected prescription drug coverage to the requirement of a balanced budget when they passed the Medicare Modernization Act. He notes that between 2010 and 2019, Medicare spending on prescription drugs is projected at $1 trillion, "Over 90 percent of that total represents the effect of the M.M.A." He continues:

And how was this vast new entitlement for the elderly financed?

Were taxes raised specifically to finance the bill? They were not. Was federal spending elsewhere cut specifically to finance the bill? It was not.

One could argue that the M.M.A was passed in 2003 because of the spirit of bipartisanship that then prevailed, particularly between President Bush and the late Senator Edward Kennedy. One could also argue that nostalgia for such bipartisanship is somewhat misplaced.