September 22, 2024
Column

Medicare prescription drug benefit up in smoke

Few things are as easy as they seem, a lesson I learned years ago at my mother’s expense. I was trying to impress my visiting girlfriend and the task before me seemed simple; the family dog had left a large bone in the yard that needed to be thrown away.

Wanting to show my girlfriend that Dan Marino had nothing on me, I lobbed the heavy bone at the trash can from about 30 feet. Unfortunately, the bone smashed straight through the back window of my mother’s car, which she had been foolish enough to park in the garage in its usual place two feet from the trash cans. I went to the doghouse and Dan went to the Super Bowl.

Two years ago passing a prescription drug benefit for Medicare recipients in the U.S. Congress looked easy. Most Americans supported the idea, politicians from across the political spectrum talked like the idea was right up there with motherhood, President Bush seemed to be in favor, and Washington was awash in budget surpluses. The idea was going places.

Two years later, the idea is legislative road kill, a hit-and-run victim of lobbying by the pharmaceutical industry, a faltering economy, last year’s tax cut, the president’s lack of commitment, and election-year politics. In August the U.S. Senate could not even pass a Medicare drug benefit for America’s poorest senior citizens. Efforts will be made to resuscitate the idea before the November congressional elections, and those running for office will pledge their undying support, but by comparison a basset hound in a strapless Halston dress has a better chance of getting a date for the prom.

The demise of a Medicare prescription drug benefit this year, especially one for the poorest American seniors, raises questions about both political parties, but primarily about whether the Republican Party is losing touch with Americans who are not in the top tax bracket.

Consider this: The principal reason there is no prescription drug benefit plan passing this year, despite support from an estimated 70 percent of voters, is that the money for it would probably have to come out of future elements of the 2001 tax cut or other Republican priorities. Even with a weak economy, had the Bush tax cut not been so large the money would have been available. It still could be; the cost of a drug benefit for the poorest seniors could be covered if future tax cuts for those in America’s richest tax bracket were axed, and current taxes on estates over $3 million were retained. Will the Republican Party leadership, with President Bush at its helm, sacrifice part of those tax cuts for the wealthy to pay the $400 billion over 10 years for a prescription drug benefit for America’s poorest senior citizens? If you think it will, would you also please let Elvis back in the building?

No matter what President Bush said to get elected, he has demonstrated little interest in a real prescription drug benefit for Medicare patients. The only benefit bill he has supported is the one passed by the Republican-controlled House of Representatives, and his support of that bill is telling. It is widely regarded as having no chance for final passage, its proposed implementation plan is probably unworkable, and it would leave a Medicare recipient responsible for up to $4,500 in prescription costs per year. It is a fig leaf plan meant only to give coverage to Republicans candidates in November’s congressional elections, and no one cares if it blows away after that.

Another reason there is no drug benefit out of Washington this year is that the pharmaceutical industry has opposed it, and the Republican Party is beholden to the industry. In the middle of this summer’s congressional debates over a Medicare drug benefit the pharmaceutical industry was the biggest sponsor of a $20 million Republican congressional fund-raising gala in Washington. That is no coincidence, nor is it that the industry often has its way in Washington and donates more than $80 million to Republican and Democratic election campaigns annually.

The Republican Party’s lack of effective support for the prescription drug benefit is a gamble that has left some of its members scrambling for political cover. Moderate Republicans such as Maine Sens. Susan Collins and Olympia Snowe have broken with party leadership and voted for one or another bipartisan drug benefit proposal in the Senate. Those Republicans also supported a bill in the Senate to increase the availability of Canadian pharmaceuticals and generic medications, contrary to the wishes of the Bush administration and the pharmaceutical industry but necessary for those like Collins who are running for re-election this November.

The Republican Party will define itself for voters in the next two years over issues such as the Medicare prescription drug benefit, and whether it continues to appear to coddle the likes of pharmaceutical companies while the rest of us lose our retirement accounts to the likes of Enron. A political party that can give two thirds of a $1.5 trillion tax break to wealthy Americans but no prescription drug benefit to middle class and poor Medicare recipients is on a path to the political doghouse. It will lose its popular base everywhere in the American middle class but on its conservative fringe, and it cannot win elections without that base.

(By the way, Dan would have muffed that shot too.)

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.


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