THERE WAS ONLY one subject that produced agreement
during the long tussle among conservatives and
progressives, Democrats and Republicans over how
to provide some measure of prescription drug insurance
for retired people and the disabled within Medicare.
subject was the cost of drugs in the United States,
something so out of control that it threatens
to undermine if not destroy the alleged benefit
that will be available to some in about three
Senator Dianne Feinstein of California, one of
those Democrats who decided to support the bill
in the end, "There is one significant missed opportunity
in this bill, and that is it contains no provisions
aimed to control the cost of prescription drugs."
Senator John McCain of Arizona, one of the few
conservatives to stick to his principles in opposition
to the creation of a major new entitlement program,
added that the subsidies to "special interests"
like insurance and drug companies stand in stark
contrast to the absence of any means of keeping
costs from skyrocketing.
particular, he noted (as did many progressives)
a truly bizarre section of the legislation that
literally prohibits the government from bargaining
over price with the drug companies and other suppliers
to beneficiaries. He also noted that this is precisely
what enables the Veterans Administration and the
core of the Medicare bureaucracy that deals with
hospitalization to keep drug prices below what
they are in pharmacies for veterans and retired
people in hospitals. It is no accident, McCain
said, that the profits of drug companies are officially
expected to grow by $9 billion as a result of
this protection from having to negotiate with
the biggest bulk purchaser of them all.
addition, Senator John Edwards (who joined fellow
presidential candidates John Kerry and Joe Lieberman
in opposition) noted that the legislation not
only puts an insuperable roadblock in front of
the re-importation of much cheaper prescriptions
from Canada, it also tweaks the antitrust laws
enough to enable drug companies to conspire to
reduce shipments to Canada in order to reduce
the supply available to Americans.
to Lieberman, there will also be nothing to prevent
drug companies from restricting the drugs available
on their lists (or formularies) to beneficiaries,
something that will limit the options of people
now getting drug coverage through former employers
or Medicaid. And several senators also noted that
proposals to greatly speed up the availability
of generic products as a substitute for patented
medicines have been greatly watered down.
result is that drug prices, and this meager program's
costs, are certain to skyrocket in the years ahead,
undermining its protections.
a few principled conservatives, this was enough
to overcome partisan loyalties. One in particular,
retiring Senator Don Nickles of Oklahoma, pointed
to an estimate by officials of the Congressional
Budget Office that while the program's cost over
the next decade is budgeted at $400 billion, an
educated guess about the following decade is more
like $1.5 trillion. And efforts to fill the legislation's
huge coverage gap for the middle class (which
is certain to produce anger as the facts become
better known) will only add to the burden of a
program for which the already hemorrhaging government
has made no provision whatsoever.
he had unconscionably muscled the Republican-written
measure through the House early Saturday morning,
Speaker Dennis Hastert of Illinois refused to
say that 10 years from now retired people will
be paying any less for drugs than they are today.
He gruffly responded that people who don't like
the benefits don't have to participate in the
program. There's compassionate conservatism for
yet -- the instinct many progressives felt to
make this flawed start was strong.
proponent, Democratic Senator Max Baucus of Montana,
said that one-third of Medicare's beneficiaries
will have at least 95 percent of their drug costs
covered; he is correct.
it, another proponent, Democratic Senator Blanche
Lincoln said that 40 percent of the beneficiaries
in Arkansas will be eligible for reduced or premium-free
insurance that has no coverage gaps.
the other hand, speaking for the forgotten middle-class,
Democratic Senator Barbara Mikulski said 200,000
retired people in Maryland will fall into that
huge gap that will require them to shoulder thousands
of dollars in out-of-pocket costs while still
paying premiums. And Senator Edward Kennedy noted
that just the imposition of an assets test on
poor people will deprive 60,000 benficiaries in
Massachusetts (and 2 million nationally) of assistance.
Senate version of this legislation, with Kennedy's
all-important support, got 77 votes last summer.
The final version -- with its private industry
subsidies and tax breaks for the wealthy added
by a stubbornly partisan House -- has eliminated
that bipartisan glow.
resulting program is President Bush's to defend
next year. Perhaps that is why its woefully inadequate
provisions are not due to take effect until 2006.
The reality will spawn waves of anger; what remains
to be seen is if the clear prospect will as well.
Oliphant's e-mail address is email@example.com.
Copyright 2003 Globe Newspaper Company.
Posted: December 5, 2003