- The Washington Times - Thursday, March 6, 2003

For those in official Washington who said that President Bush would be too distracted with the war against Iraq to promote a dynamic domestic agenda, the newest version of the president's plan to modernize and improve Medicare demolishes the conventional wisdom. His proposal to give seniors a choice to stay in the existing Medicare program or take the money and join a private health plan to the horror of the Democratic Party (and some Republicans) is the most dramatic domestic policy initiative since the introduction of Medicare in 1965. Unfortunately, his own party is abandoning the president before the battle for reform has even been waged.
It was rumored that the president would simply add a drug benefit to the existing Medicare plan and spell out some broad principles for Medicare reform in yesterday's speech. He went far beyond that. He articulated a very specific plan, one that clearly moves Medicare including drug coverage into the marketplace. Conversations with top administration officials suggest that the president regards fixing Medicare as next to the economy his most important domestic issue. At the very least, it is clear that the president sees the growth of entitlements as a challenge that he must and will deal with.
But, in this regard, it appears that he stands alone, even in his own party. The president's initial Medicare proposal was hooted at and derided as being thin on details and portrayed as a plan to force seniors to join managed care plans to get prescription drug coverage. It turns out that the characterization came largely from Republicans who wanted a hand in crafting the proposal because they want a stand-alone drug benefit for seniors in the current Medicare program. Indeed, despite the fact the president's revised plan would extend prescription drug coverage to those in the existing system, Republicans still refuse to support reform. Indeed, the president was hoping that Republicans would help flesh out the details of his market-driven approach. Instead, as Rep. Billy Tauzin, chairman of the House Energy and Commerce Committee said, they want a "strong and adequate prescription drug benefit within fee-for-service." That goes for Sen. Charles Grassley, who chairs the Senate Finance Committee, and House Speaker Dennis Hastert. Only Majority Leader Bill Frist, like Joshua of old, has refused to spurn the Bush plan and join in the revelry around the golden calf of free drugs for geezers regardless of income
Could the president have predicted such a wholesale retreat on principle? Republicans will support drug giveaways to rich and healthy seniors at election time and for time immemorial, instead of asking seniors to make responsible choices with tax dollars about the best kind of health plan for them. Under every prescription drug plan proposed last year, most of the benefits would go to well-to-do seniors. Plans in the works would just increase coverage for wealthier seniors. Seniors would have to shell out co-pays and deductibles before they saw a dime in drug benefits. At the same time, drug costs would be curtailed by limiting access to the newer and better medicines or resorting to research- draining tricks such as allowing generic companies to copy innovative drugs before their patents run out or encourage the importation of drugs from anywhere in the world via Canada.
By contrast, in the private sector, drugs are fully integrated into health plans without any additional deductible or co-pays. Unlike government-run systems, private plans do not have drug lists that restrict access and are faster to add new drugs as they come to market.
Republicans have failed to think through any portion of the president's plan, from the issue of access to new medicines to the growing problem of rampant entitlements. The sellout of the President has been so rapid and so complete it is breathtaking. Faced with a situation where their president needed backing, the Republicans didn't even toss him a bone. Just as North Korea has been exploiting Mr. Bush's attention on Iraq for global political advantage, our politicians at home have been using the president's focus on war and terror to gain some sort of upper hand on domestic politics.
The gain will be transitory. The president's attention may be diverted, but not his resolve. A stand-alone drug benefit will not stand for long. Simply adding drug coverage is no longer a guaranteed way to buy votes. There are millions of Americans who are concerned about the fiscal future of Medicare, as well as the issue of prescriptions for seniors. They know, it is irresponsible to add a drug benefit without restructuring the way we pay for Medicare and how care is provided. Presidential leadership will be required to bring about these changes. That the president took time from the war effort to focus on Medicare suggests that it will be at hand when it is necessary. Republicans should have their lead on Medicare politics from the president instead of Paris.

Robert Goldberg is director of the Manhattan Institute's Center for Medical Progress.

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