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Medicare reform backfires on Bush

President Bush signed a prescription-drug act two months ago that is actually hurting his popularity instead of boosting support from the elderly as intended.

A Gallup survey found that public disapproval of Mr. Bush's handling of health care has increased 13 percentage points since last year. The Jan. 19-Feb. 1 survey found 57 percent of the 1,001 Americans surveyed disapprove of Mr. Bush's health care policies, compared to 35 percent of voters who approve.

Mr. Bush finds himself under fire from two directions on the health care issue. Democrats say the Medicare plan doesn't do enough to defray prescription expenses for retirees, and Republican critics call the drug benefit an unprincipled bid to buy votes in November.

Critics accuse the Bush administration of lying about the bill's cost to taxpayers. While pushing the Medicare bill on Capitol Hill, the White House estimated the new drug benefit would cost $400 billion over the next 10 years. But when Mr. Bush released his fiscal 2005 budget earlier this month, that cost was estimated at $534 billion.

The bill Mr. Bush signed subsidizes drug costs for low-income patients and encourages private insurance companies to offer coverage for retirees willing to opt out of the traditional Medicare system. Some conservatives praised the plan's provision for tax-free medical savings accounts, a policy long advocated by Republicans.

Many Republicans had hoped the Medicare changes would help the president and his party score points on an issue where Democrats have long enjoyed an advantage, especially among older voters.

"It was clearly political," said health policy analyst Edmund Haislmaier. "The Bush strategists were trying to get the elderly vote."

Where the White House saw hope for a political edge, many in the GOP saw a shameless sellout.

Before joining 24 other Republicans in voting against the bill, Arizona Rep. Jeff Flake said that the new measure "flies in the face of the principles of limited government and individual responsibility that Republicans are supposed to stand for."

The bill looked like "nothing more than an extremely expensive way to buy votes," Mr. Flake said.

Originally promoted as a market-oriented reform by its Republican supporters, the final bill proved to be an unsatisfying compromise, said Mr. Haislmaier, a visiting fellow in health policy at the Heritage Foundation

"The idea was that adding a new drug benefit would buy liberal and elderly support for transforming Medicare from a bureaucratic, provider-centered program into a true, consumer-driven program," he said. "But what they ended up with was a hugely expanded government program with virtually no reform."

Conservative ire might have been an acceptable political cost if, as some strategists had expected, the Medicare bill boosted support for Mr. Bush and the Republican Party among older voters. But that hasn't happened -- in fact, the opposite has apparently been true, as retirees seemed to heed Democrats who denounced the bill.

"So far, the health care gamble hasn't paid off for the president," Mr. Haislmaier said.

Democrats are condemning a provision in the act that bars the government from negotiating lower prices from drug companies.

Sen. John Edwards, North Carolina Democrat, called the bill "a giveaway to HMOs and insurance companies."

Under the provision, "we cannot even allow the government to use its bargaining power to bring down the costs of prescription drugs for all seniors," said Mr. Edwards, who is seeking the Democratic presidential nomination.

That provision "doesn't make sense," said the Democratic front-runner, Massachusetts Sen. John Kerry.

In fact, Mr. Kerry, along with Sen. Edward M. Kennedy, Massachusetts Democrat, sponsored a bill with a similar provision in 2000, and a similar measure was endorsed in the House by Democratic Reps. Dennis J. Kucinich of Ohio, John D. Dingell of Michigan and Henry A. Waxman of California.

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