Zero hour for prescription drugs

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Last week, President Bush pressed the House and Senate to reach a speedy agreement on a prescription-drug subsidy for seniors. "Now is the time to finish the work," he said. One deadline for crafting a deal by mid-October was missed, and there are only three weeks left before Congress leaves for Thanksgiving, which had been the target date for completing all legislative business this year. Failure to pass a prescription-drug bill would be political bad news for Republicans, who control both houses of Congress and the White House.

To date, House negotiators have bargained away some market measures, but leaders are trying to prevent reimportation of medicines from foreign countries. Of the conferees, only three out of 12 voted for reimportation, but one is Charles Grassley, chairman of the Senate Finance Committee. He said last week, "Imports create competition and keep domestic industry more responsive to consumers." This just isn't so. Foreign drugs are cheaper because of artificial price controls. However, despite the fact that reimportation bills passed the Senate 62-28 in June and the House by 243-186 in July, only a handful of votes for a prescription-drug law are tied to reimportation.

House Ways and Means Committee Chairman Bill Thomas is seeking a compromise through a pilot program to allow drugs from Canada, but opponents argue convincingly that this would be impossible to end once it's started. Sources in both the House and Senate tell us that it is probable that final agreement will have a reimportation provision, but it will prevent the floodgates from opening the market to foreign price-controlled medicines. The Food and Drug Administration (FDA) would have to certify safety of foreign drugs, a process the agency has said is impossible. The plan is to let members have it both ways: Reimportation will be allowed but with a safety clause mandating FDA certification, which effectively kills the option.

The biggest problem now is cost containment. Conservatives worry that the agreed $350 billion price tag will be only a fraction of the actual cost. Liberals insist that guaranteeing comprehensive national coverage trumps cost. Under usual circumstances, legislative loggerheads can be removed by adding spending to convince reluctant members to vote for a package. But spending is the issue this time. One compromise that has helped cost control is a provision for higher premiums for higher-income recipients -- a deal that shows progress is being made.

By 2012, the Congressional Budget Office estimates that seniors will spend almost $2 trillion on prescriptions, yet approximately 60 million Americans do not have coverage. About 30 percent of seniors cannot pay for the drugs they need. An AARP survey of Americans 45 years old and older shows that 80 percent support prescription-drug coverage. Recalcitrant legislators might remember that retirees vote more than anyone else.

There is no question that Congress should do what it takes to get a prescription-drug package done. But the White House can do more to help. By refusing to take positions on the contentious issues still being debated, the president is missing the opportunity to use the full power of his office to reach his policy goals.