- The Washington Times - Friday, October 13, 2000

Before they are conned by the false promise of something for nothing, senior citizens need to think twice about the prescription drug plans being touted by Al Gore and George W. Bush, as the presidential candidates make the rounds of retirement homes and senior citizen centers.
The questions are not difficult: First, should Medicare include prescription drug coverage? Second, should the Medicare program be expanded to provide coverage to people younger than 65 who need medical insurance? Third, if new benefits are added, how will they affect the program's finances? Fourth, does it make any sense to add to Medicare's financial burdens without fixing the program itself? And last, is there a way to provide prescription drug coverage without hastening the financial collapse of the program?
The first question is easy to answer. While there are disagreements about the exact number of seniors who lack prescription coverage, it is clear prescription drugs are revolutionizing medicine in ways that were impossible to imagine when Medicare was established. It is simply no longer possible to receive proper medical care without having access to the full range of miracle medicines available at the neighborhood pharmacy. Seniors deserve no less.
The second question should Medicare be expanded to cover people who are not yet 65? has received little attention to date. Mr. Gore would extend Medicare coverage to those between the ages of 55 and 65, though Medicare cannot adequately cover the health needs of those over 65. How can the program include millions of additional beneficiaries without threatening the coverage seniors now receive, and without plunging the program into red ink sooner than predicted?
Providing Medicare coverage to non-seniors would set a dangerous precedent. Medicare is not the nation's health insurance program. It was designed to address the needs of seniors and should be left that way.
Having said that, however, we must not forget that the current program even without a drug benefit is nearing collapse. As investment banker Peter Peterson, author of "Gray Dawn: How the Coming Age Wave Will Transform America and the World," noted recently in the New York Times, few Americans have honestly confronted "the magnitude of what looms ahead" for Medicare. Without a prescription drug benefit, Mr. Peterson noted, Medicare Part A, which covers in-patient hospital bills, faces a $12 trillion deficit over the next 75 years. Trillions more will be needed to finance Medicare Part B, which covers doctor bills, home health services and "other outpatient costs."
The Social Security deficit over the same 75-year period is estimated at $21 trillion. Since neither the Medicare trust funds, nor the Social Security trust fund, have any real money in them, these deficits will have to be paid for out of general revenues. Neither candidate has said where the government will get that kind of money.
The demographic news also is ominous. Already, Mr. Peterson noted, 35 percent of the budget is spent on programs for seniors up from 16 percent in 1965. The coming retirement of the Baby Boom generation will rapidly drive these costs higher. According to reliable estimates, 84 percent of the total federal budget will be spent on programs for seniors by 2050. The addition of prescription drug coverage will speed the collapse of Medicare if not part of a broader reform effort.
The next two questions go hand-in-hand. First, there is a way to provide prescription drug coverage without hastening Medicare's collapse but it can only be done within the context of Medicare reform.
Mr. Gore's $360 billion prescription drug plan, almost identical to the one proposed by President Clinton earlier this year, would add to both the cost and complexity of Medicare. It also would establish still another layer of regulatory bureaucracy some 412 new government "mandates" and 182 rules or controls "governing the delivery of prescription drugs," according to one recent study that would undoubtedly be used to put the squeeze on costs when Washington panics from the coming tide of red ink. Considering Mr. Gore's relentless attacks on the pharmaceutical industry, his government-knows-best approach to prescription benefits should come as no surprise.
While Mr. Bush's plan is still a work in progress (as is Mr. Gore's) it is at least based on a workable model: the Federal Employees Health Benefits Program (FEHBP), which provides a full range of health coverage to 9 million federal government employees, retirees and their dependents.
Under the FEHBP model, which was endorsed by the National Bipartisan Commission on the Future of Medicare, government employees and retirees choose from a wide range of medical plans, including traditional "fee-for- service" insurance, "preferred provider" coverage, and health-maintenance organizations (HMOs). The government subsidizes the purchase of the coverage. All the plans must provide protection against catastrophic illness (something Medicare still does not do), and virtually all of them provide generous drug benefits, as well as "wellness" coverage and other desirable benefits. And if you don't like the plan you're in, you can switch to another.
Sen. John Breaux, Louisiana Democrat, Chairman of the Bipartisan Commission on the Future of Medicare, is cosponsoring legislation with Sen. Bill Frist, Tennessee Republican (one of few doctors in Congress), that would put Medicare on sound financial footing and provide a meaningful drug benefit by making the program more like FEHBP.
This is the prudent way to provide a prescription drug benefit: as part of a larger effort to update Medicare. To that end, Medicare reform should provide maximum flexibility to seniors, protect the original concept of Medicare being offered only to seniors, and minimize government regulation. The United Seniors Association encourages all voters to know the facts before they decide for whom to vote on Nov. 7.

Sandra Butler is president of the United Seniors Association, a non-partisan grass-roots organization representing more than 600,000 senior citizens.

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