Jewish World Review Dec. 2, 2003 / 7 Kislev 5764
Medicare reform: A real turkey of a package
I find Senate Majority Leader Bill Frist to be a thoroughly likeable man, so I hate to hear him say something that is not quite true.
"As a physician, I have written hundreds of prescriptions that I knew would go unfilled because patients simply would not be able to afford them," the Tennessee Republican said after Congress finally passed a bill last week to help older Americans pay for prescription drugs. "With this bill, that would change."
Whoa. That sad situation may change for some hard-pressed elderly, but not for nearly as many as this bill could have helped. Instead, congressional negotiators slipped behind closed doors and packed the package full of giveaways to the insurance and pharmaceutical industries and other not-so-needy folks.
An examination by the Center for Budget and Policy Priorities, a liberal Washington-based think tank on poverty issues, found that some low- and moderate-income beneficiaries now without drug coverage would, indeed, gain assistance with some of their prescription costs. But many of the poorest and sickest seniors actually could find themselves with less drug coverage than they now have under Medicaid, the nation's health-care program for the poor.
They also could lose coverage for certain drugs altogether if Medicaid covers the drugs but the private plan that administers the Medicare drug benefit in their area does not.
Among other goodies, the measure also offers new "health savings accounts," that closely resemble a stealth version of a tax cut for the wealthy. It also offers billions of dollars in other new subsidies to try to keep private plans in the Medicare market and lure back some of the plans that have been leaving in recent years.
Cost containment? Forget about it. The legislation forbids Medicare from using its huge pool of patients to negotiate lower prices from the drug companies. That smacks of price controls, a no-no in the conservative playbook, even though price negotiations appear to work just fine with defense contractors and others who want to do business with government programs.
And the bill is far more complicated than it needs to be. The new benefit covers about 75 percent of drug costs up to $2,250 a year, after the Medicare beneficiary pays the first $250 of drug costs. Then the so-called "doughnut hole" kicks in. Between $2,250 and $5,100 in drug costs, Medicare recipients pay all of their costs. For recipients who pay more than $3,600 (for a total of $5,100 in prescription drugs), Medicare pays 95 percent of the cost of each prescription.
Why the "doughnut?" I expect a lot of seniors will be asking that question as they figure out this Thanksgiving turkey. By then, the White House undoubtedly hopes, we will be long past the 2004 election, since the new benefit does not kick in until 2006.
This bill would not have gotten through, I suspect, if the Democratic Party was still alive. Democrats did make some noise and Senate Minority Leader Tom Daschle of South Dakota later introduced legislation to repeal some provisions and allow Americans to import cheaper drugs from Canada and western Europe.
But for the most part, the bill got through because disciplined and well-organized Republicans outmaneuvered disunited Democrats, some of whom crossed over to the Republican side because they did not want to be seen as opposing any drug program for the elderly, even a badly flawed one, or opposing free enterprise.
Sen. Orrin Hatch (R-Utah) chided Democrats, saying they opposed the bill because they wanted to spend twice as much money and "don't believe in the private sector." Actually, supporters of this bill must not have complete faith in the private sector either or they wouldn't think private insurers would need billions in subsidies to keep them in the Medicare market.
No, you don't have to be a liberal Democrat to believe that you cannot always trust the private sector to meet the health care needs of yourself and your family as reliably as Medicare has. Unlike private insurers, for example, Medicare is not known for notifying retirees that their health insurance may be cut because their business is no longer otherwise desirable.
Now it is up to the public to let Congress know what it thinks of this Thanksgiving turkey. With a little prodding, negotiators might return to an open debate about the long- range problems of Medicare and produce a simpler prescription drug benefit, one that Americans across the spectrums of politics and income can support.
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