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Still Hope for a Drug Benefit

July 31, 2002

Every member of Congress knows that adjourning without passing a prescription drug benefit for the elderly will lead to a campaign dirt-fest and waves of voter recrimination over who killed drug reform. On Tuesday, it looked as if a last-gasp effort in the Senate would be voted down. But the vote was delayed overnight, and today could bring some changes of heart.

Two good measures are still alive: One, by Sens. Bob Graham (D-Fla.) and Gordon Smith (R-Ore.), would add a prescription drug benefit to Medicare. The other, by Sens. John McCain (R-Ariz.) and Charles E. Schumer (D-N.Y.), would prevent producers of brand-name drugs from using legal chicanery to delay generic-drug competition.

The need for McCain and Schumer's bill, S 812, was abundantly clear Tuesday when the Federal Trade Commission released a report concluding that brand-name drug makers often smother competition by paying generic companies to keep their products off the market or filing bogus patent extensions.

Graham, Smith and Senate Majority Leader Tom Daschle (D-S.D.) are trying to attract the 60 votes the measure needs to pass. Therein lies plenty of room for last-minute mischief.

The Graham-Smith measure is a sensible compromise between Republican and Democratic plans. It would provide complete drug coverage for some low-income people--for example, couples on Medicare with annual incomes under $23,880--but only "catastrophic" coverage for more affluent beneficiaries whose out-of-pocket drug costs exceeded $3,300. For the seriously ill, that's not hard to reach. A new pill to ease lung cancer symptoms, for instance, is predicted to cost $2,000 a month for a daily dose.

The danger is that Daschle, Graham and Smith will agree to GOP demands that managed-care companies be allowed more "freedom." That could let drug companies join with HMOs so their drugs would be discounted, while other companies' wouldn't. The senators should not need to watch "John Q" to recognize that letting HMOs control access to treatments without federal oversight is a bad idea.

Though the Graham-Smith bill would allow managed-care plans to deliver the new benefit, it would require Medicare to decide certain basics, such as which drugs would be covered. Medicare has done a generally good job of deciding what inpatient treatments are cost-effective. The same principles should guide an outpatient prescription drug benefit.

Daschle may not get the votes needed to pass the drug benefit. Both political parties already are taking out radio ads for this fall's election blaming each other for failure of drug benefit legislation. But it's still possible to hope. And if lawmakers indeed pass a bill, then perhaps Congress can also find the courage to modify the tax cut bill to cover the new benefit. In a choice between Mom's pills and a tax benefit mostly for the wealthy, guess what wins the hearts of voters.

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