Bush Must Push Or Medicare Drug Plan Will Die Again

Posted September 26, 2003 at 1:58pm

President Bush finally got around to intervening in the Medicare prescription drug stalemate last week, but unless he makes it a major priority, the benefit looks dead for yet another Congress.

[IMGCAP(1)]Even though House and Senate conferees and administration officials stoutly insist they’ll produce a bill by Oct. 17, there is talk of “fallback options” — and there should be.

But instead of adopting the now-blazingly popular idea of lowering drug costs by permitting mass reimportation from Canada — which will cost lives by curtailing pharmaceutical research — Congress and the White House should be considering a benefit for low-income seniors and those with catastrophically high drug bills.

A bipartisan group of back-benchers is quietly working with Jeff Lemieux, executive director of a new think tank called Centrists.org, to develop such an alternative.

A variant of proposals introduced this year by Reps. Cal Dooley (D-Calif.) and Ellen Tauscher (D-Calif.) and last year by Sen. Chuck Hagel (R-Neb.), Lemieux’s proposal calls for the government to pay all drug expenses after a senior has spent $4,000.

Also, in a variant on a widely backed stopgap measure, all seniors would get drug discount cards reducing their outlays by 10 percent or 20 percent, with low-income seniors getting a “balance” on their cards of up to $1,500 a year.

“Fallbacks” are not what anyone wants, but at the moment they are likely to be all that’s possible unless the president insists that Congressional Republicans quit squabbling and produce a measure that can pass.

Both the House and Senate have passed “comprehensive” bills that would provide prescription drug benefits to all Medicare recipients, but conferees are having difficulty reaching agreement on a final bill.

A House GOP memo marked “PRIVILEGED AND CONFIDENTIAL” set out a timetable for producing a conference report by Oct. 17, but the conferees reportedly are far behind schedule.

The memo said that “it is important that both staff and Members refrain from discussing the specific nature of the compromise alternatives with the press and those not on the Conference committee.”

Nonetheless, it’s clear to everyone what the barriers are to an agreement: hostile relations between Ways and Means Chairman Bill Thomas (R-Calif.) and Senate Finance Chairman Chuck Grassley (R-Iowa) and ultimatums issued by House conservatives and Senate Democrats.

House conservatives insist they will not vote for any bill that does not ultimately force the government-run Medicare system to compete with private insurance plans.

They are convinced that, without so-called “premium support,” the prescription drug benefit will cost much more than the budgeted $400 billion over 10 years and, when the baby boom generation retires, will destroy the nation’s fiscal health.

The conservatives have the votes to prevent an unsatisfactory bill from passing the House. But Senate Democrats say they will filibuster any bill that contains “premium support,” which they regard as an attempt to “privatize” Medicare.

An additional problem is that both the House and Senate bills could well result in seniors losing current benefits provided in their employee retirement plans.

And many seniors are convinced that, because of cost-containment features in both bills, they will pay more in premiums than they will ever receive in benefits.

If Congress fails to pass a comprehensive bill, it’s likely that various add-on proposals will also fail — such as a mandate that Medicare cover so-called “self-injectibles,” drugs that patients can administer to themselves with injections through the skin. Theoretically, covering “self-injectibles” could save millions of dollars if Medicare fees don’t have to be paid to doctors’ offices to inject medicines.

Bush met last Thursday with House and Senate conferees for what he described as a “frank” discussion about Medicare, but there is no indication that he plans to get personally involved in forcing compromises.

Another step apparently necessary to produce agreement may be a takeover of the negotiations by Senate Majority Leader Bill Frist (R-Tenn.) and Speaker Dennis Hastert (R-Ill.).

So, while the conferees and administration officials insist that an agreement can be reached, outsiders are convinced that a “comprehensive” bill is dead and that Congress will produce merely a “little bill” costing about $35 billion over 10 years.

Items reportedly in it will include a discount card for all seniors, aid to rural medical centers (a Grassley priority), higher payments to Medicare HMOs (a Thomas priority), a measure to lower prices by eliminating barriers to production of generic drugs — and reimportation.

The Bush administration formerly opposed the idea of reimporting U.S. drugs on the grounds that their safety could not be guaranteed, but some health care lobbyists claim that administration resistance is weakening in the face of the runaway popularity of the idea.

A “little bill” might contain a provision permitting reimports only from Canada, where purity standards are higher.

The governors of Illinois, Iowa and Minnesota all are contemplating mass imports from Canada to cut their Medicaid budgets.

Drugs are cheaper in Canada because prices are controlled there. Reimportation would cost pharmaceutical companies billions of dollars, limiting their ability to perform expensive research leading to new drugs to cure disease.

The reimportation plan is simply odious, condemning people to death to save money and allow politicians to provide a benefit to constituents at someone else’s expense.

The better way to make drugs cheaper is to pass a Medicare benefit bill — aiding the neediest first, if a “big” bill is politically impossible. But that requires active White House leadership.