Medicare Prescription for Disaster

AUSTIN, Texas -- Food fight! Here's a beauty: to vote or not to vote, to favor or not to favor the Medicare Prescription Drug Bill?

Theoretically, everybody's in favor of a plan to help senior citizens with prescription drug costs, which are truly appalling. Many seniors literally have to choose between their meds or food. Everyone agrees it's awful -- the question is whether the bills currently in the House and Senate are actually an improvement.

Those of you who make up your minds based on the if-he's-for-it, I'm-against-it method (quite a few people seem to be doing that these days) are in deep doo-doo on this one. True, Ted Kennedy is for it, and The Wall Street Journal is against it. On the other hand, the White House is for it, and pretty much everyone on the left except Kennedy is against it. The press is helpfully wringing its hands and announcing, "This is soooo complicated."

So let's try the unusual maneuver of actually looking at the merits of the thing. If you put, as Consumer Reports has helpfully done, the hybrid House Republican/Bush bill up against the Democrats' version by the respected Medicare expert John Dingell, it's no contest. The Democratic bill is better in every respect -- except, of course, it costs more. It has the additional flaw of being unlikely to pass in the Republican House.

In fact, the Republicans are not entirely sure they can get their own awful version passed. For starters, the Republican version covers, at best, 22 percent of projected prescription drug expenditures. It includes a $250 deductible, 20 percent coinsurance up to $1,000 and 50 percent coinsurance on $1,001 to $2,000, and costs an extra $35 a month. There's an even weirder hitch called "the doughnut," a hole in the middle, that leaves seniors spending between $4,500 and $5,800 uncovered.

Don't even ask how that got in there -- you don't want to know about that bit of sausage-making.

According to CR's calculations, the average Medicare beneficiary now spending $2,318 for meds would find the out-of-pocket cost under the Republican version higher in 2007, a total of $2,954 in constant dollars. Under the Senate bill, CRE estimates the same $2,318 would come to $2,524 in 2007, including premium, deductible, co-payments and the "doughnut."

"If the growth of prescription drug expenditures moderates below historical levels to 12 percent a year (and this is unlikely because neither bill includes sufficient safeguards to hold down drug prices), the average Medicare beneficiary would still face, under the House bill, out-of-pocket costs in 2007 that are approximately the same as they are now. Under the Senate bill, out-of-pocket costs would be only marginally lower than those of 2003," concludes CR.

So here's the politics on the deal. Kennedy is supporting the Senate version because (A) it's marginally better than what we have now and (B) in one of the hoariest cliches of political debate, this gets the head of the camel into the tent. In other words, it's a start, and a better program can be built later -- in fact, it pretty much will have to be. The White House's logic is (A) Republicans promised a prescription drug benefit and (B) they can pass this in time for the 2004 election and take credit for it, but it doesn't go into effect until 2006 (a clever ploy), so no one will have time to figure out it's a fraud.

Of course, the Republicans originally wanted to use this as a tool to break down Medicare completely, insisting on more "private sector" involvement. Bush initially planned to use the bill to herd seniors into HMOs. Since private insurance companies refuse to serve seniors in rural areas and have already dropped 2.4 million seniors in "unprofitable" areas, and since seniors in private plans are getting hit with soaring premiums and shrinking benefits, that's a non-starter.

The biggest missed opportunity in both House and Senate versions was not using any tool to rein in drug company profits. (Please note generous contributions by drug companies to politicians of both parties.) The loopholes that delay the introduction of generic drugs should be plugged up, and the government should use its purchasing power to negotiate lower prices.

Bottom line, Kennedy's right: The Senate version is incrementally better, and in politics, you should always take half a loaf, or even 22 percent of a loaf, if you can get it. But if the Senate version is even slightly weakened by the repulsive House version, fuhgeddaboutit.

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