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Patient Shouldn't Be Saved

November 20, 2003

Republican leaders in Congress, made bold by feverish lobbying from the Bush administration and a $7-million ad campaign launched this week by the seniors organization AARP, are on a final push to add a $400-billion drug benefit to Medicare. Such a benefit was a campaign promise by President Bush, and few members of Congress want to say no in an election year. But the Medicare bill is such a complicated mess, full of concessions to one interest group after another, that it actually stands a chance of being defeated. It should be, especially in this year of record deficits.

It is full of tortuous detail that is poorly understood by legislators, much less the public. It is opposed by some fiscal conservatives for its absence of cost controls and by liberals because it aims to push more of the elderly into private insurance programs.

The final text of the bill has not been released, meaning GOP leaders are worried and still tinkering. It's true that there are simple changes that would improve it. For instance, there is broad bipartisan support for bolstering a ridiculously weak provision asking the Food and Drug Administration to consider legalizing prescription drug purchases from Canada. The measure should require, not ask. If the government won't help control costs, it has no business stopping the free market from doing so.

The proposal not only fails to include cost controls; it prohibits them by barring government from negotiating better drug prices, a cost-saving tactic employed by many countries, including Canada.

A more fundamental problem is that, beyond the drug benefit, the bill would force traditional Medicare to compete with private managed-care organizations. A previous experiment with privatization left thousands of people stranded when their HMOs suddenly left the market. There's also the likelihood of "cherry-picking," industry parlance for signing up the healthy and discouraging the most needy and expensive with carefully manipulated advertising.

There is, frankly, zero chance that legislators will correct the proposal's biggest flaws. The freedom the proposal gives to private insurers is the foundation for the pharmaceutical industry's support of it. Though the drug industry fought government attempts to add a prescription drug benefit to Medicare in the 1990s, its lobbyists told legislators in 1999 that they would reverse course if Congress agreed to funnel the benefit through private plans.

Individual seniors don't do nearly as well as insurers. After a monthly fee and a co-pay on each prescription, plus a limit over which they get no help until reaching another level, the benefit for many people is meager.

A spokesman for the measure's staunchest opponent, Sen. Edward M. Kennedy (D-Mass.), called the proposal "a turkey of a bill." The contrast between its handsome rewards to the drug industry and its skimpy benefits to consumers recalls another holiday symbol: Mr. Scrooge. No amount of tinkering will fix this bill. Congress shouldn't be obligating the Treasury for $400 billion. For that amount, lawmakers should have done much better.

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