Placebo n, (from the Latin “I shall please”): an inert medication used for its psychological effect or for purposes of comparison in an experiment.

The Medicare Prescription Drug Discount Program announced recently by President Bush is evidence that anyone can prescribe a placebo, although probably only a president can prescribe one that will cost about $150 billion. The so-called Medicare-Rx Plan fits the Webster’s Dictionary definition of placebo to a “p”; it is functionally inert as a real remedy for the costs of prescription drugs for Medicare recipients, but has the effect of making it appear the president has actually done something.

Details of the plan are sketchy and likely to take months to work out, but its future is dim. Opponents have already filed suit to block its implementation, Congress is working on alternatives, and the concept assumes that private companies will voluntarily sign up to manage the program. The plan’s card may be more helpful ground up and taken as a fiber supplement.

For the White House and its primarily Republican allies in the U.S. Congress, alternatives to the Medicare Rx (Placebo) Plan were downright ugly. They had to do something or risk Bush looking like a presidential hitchhiker on health care issues, a lonely dot in the rearview mirror of a carload of congressional Democrats and state governments speeding down the road with their own remedies.

Opinion polls show tremendous support for a Medicare prescription drug benefit from Republican and Democrat voters alike. Candidate Bush promised during the presidential campaign last year that he would deliver one as president. Failure to deliver will hand the congressional Democrats a stick with which to smack him regularly in the 2004 presidential elections, and their own Republican opponents in U.S. House and Senate elections in 2002.

Real medicine for this problem, on the other hand, will be a hard pill for Bush to swallow. First, he has already given us the closest thing to a real Medicare prescription drug benefit likely to emerge from the White House in the next four years, that being his tax cut. The tax cut version of the Medicare prescription drug plan works like this: If you are a Medicare recipient without a big income but on a lot of medicines, just hand that tax refund check over to your drug store. A Medicare prescription drug benefit worth much will cost more than $300 billion over the next 10 years, and the tax cut will make it unaffordable without cutting the dollars loose from somewhere else in the budget.

Second, a comprehensive, effective Medicare drug plan would run Bush and the Congress right into the buzz saw of the pharmaceutical industry and its Washington lobbyists. A Medicare drug benefit that works will have to force deep cuts in prescription prices, and even then the colossal bill for all of those pills might lead quickly to more efforts to control prescription drug prices.

The pharmaceutical industry is so paranoid about the impact a real Medicare prescription drug benefit would have on its profits that it helped set up an organization called Citizens For A Better Medicare to block such a benefit. The organization purports to work on behalf of seniors to protect Medicare, but its real goal is to fight against the Medicare benefit seniors now want most, a prescription drug benefit. Even in Washington it does not get any more slick than that.

The best proposal for a Medicare prescription drug benefit now in the Congress is that of Florida Senator Robert Graham, and it is the one most deserving of public support. The Medicare Rx Plan was proposed in part to siphon public support from the Graham proposal. Without that support it is doomed; it costs more than the Medicare Rx Program, there is a monthly charge to seniors because that is the only way it is affordable after the tax cut, and it is opposed by the White House. In addition, some Democrats are in no rush to pass a real plan because they want to blame the lack of one on Bush.

The key with placebos such as the Medicare Rx Plan is not to be fooled into thinking they are real medicine, or placebos are all you will get. A real prescription drug benefit for Medicare will be identifiable by its bad taste; it will be costly, and will have to limit doctor and patient medication choice to be affordable. It will not come out of Washington unless the American public says it will accept no substitute. The only way we are going to make that happen is if we are willing to administer strong medicine at the polls if all we keep getting out of Washington is placebos.

Erik Steele, D.O. is the administrator for emergency services at Eastern Maine Medical Center and is on the staff for emergency department coverage at six hospitals in the Bangor Daily News coverage area.