| YourDoctorintheFamily.com |
|
Arguments, accusations, innuendos, competing promises, marching out of the House chamber en mass - the fight over who will be the first to offer a drug benefit to our elderly citizens has taken on all the acrimony and all the theatrics of the Clinton impeachment debate. It all seems so confusing. Both parties, after all, seem determined to provide this expensive new entitlement in one form or another - so why all the animosity? As a public service, YourDoctorintheFamily.com now provides a scorecard so you can keep track of what's really going on here. |
|
Why a Medicare drug benefit now? Drugs are extraordinarily expensive, but they have been for a long time. During my 20 years of practice, I was often faced with patients who simply could not afford the drug therapy I thought they needed in order to maintain their health. Many of these were elderly, but frankly, many were not. I and many other doctors have long felt that something needed to be done to help those who could not buy needed medications. (Many of these unfortunates, by the way, were workers who were subsidizing - through their taxes - not only Medicare benefits for the elderly, but also "private" insurance benefits for those lucky enough to receive health insurance through their employers.) So the inability to pay for prescription drugs is not a new problem that suddenly needs to be addressed, on an emergency basis, in the year 2000. The problem has been there for decades. The uproar over the Medicare drug benefit, then, does not represent any new realities. It's just that, for whatever reason, insisting on a Medicare drug benefit has become the proxy, in this election year, for demonstrating one's concern for the growing health care crisis. Actually addressing that health care crisis is, of course, out of the question. The Clintons were brave enough to try during their first two years in office, but made such a botch of the job that it cost them the House and Senate, and knocked the president's liberal agenda completely off track for the remainder of his terms. (His major successes - such as balancing the budget - were made by usurping traditionally Republican issues, much to the frustration of the GOP.) No political party will ever again directly take on the health care crisis until forced to do so by unavoidable circumstances. The Patient's Bill of Rights appeared to be, for a long time, this year's emblem of concern for the health care crisis. But that bill is bogged down, and neither party shows much interest in moving it very far - or even talking about it much - before the election. Enter the Medicare drug benefit. The price of drugs - and the vilification of the drug industry that promotes those high prices - has been a growing theme in the media, in several state legislatures, and more recently, in the U.S. Congress, all year. (Those of you who have been following these commentaries - especially the series of commentaries called Philip Morrising the Drug Companies - will recognize the theme.) The theme of high drug prices has reached such a pitch that, when various Democrats proposed offering prescription drug coverage to Medicare patients a few months ago, the notion struck a chord. The AARP, the media, and even several Republicans, jumped on the idea. In no time, the Medicare drug benefit had become the means of demonstrating concern over the state of our health care system. What the Gekkonians are up to Providing prescription drug coverage for Medicare
patients - no matter how it is done - is a bitter pill for Gekkonians to
swallow. Whatever form it may take, it amounts to a huge,
federally-guaranteed new entitlement - an outcome that any Gekkonian worth
his or her salt would abhor. Furthermore, as I pointed out in a prior
commentary, any federal drug guarantee for the elderly
creates an immediate problem for two major Gekkonian
constituencies - health plans and pharmaceutical companies.
Managed care plans, already in grave financial straits, fear
they’d be left holding the bill for any federally-mandated drug
coverage. And drug companies
fear they’ll be faced with federal price controls. Yet, the Gekkonians
found themselves about to be outflanked by the Clintonians on an issue
that seemed to carry huge political weight, and were thus forced to act
despite their constitutional proclivities. The proposed Republican
legislation (that narrowly passed the House on June 28), would provide federal subsidies for private insurance
companies, to entice those companies to create a new form of insurance
that covered only prescription drug costs.
Despite the steadfast assertion of major health insurance companies
that they do not intend to sell such insurance, Republicans propose to set
$40 billion aside to subsidize it. In
the “unlikely event” that private drug insurance would not change
their minds, the government would become the insurer of last resort under
the G.O.P. plan. In addition, the Republican plan calls for creation of a new federal agency (the Medicare Oversight and Management Administration) to oversee drug benefits and Medicare HMOs. This new agency, unlike present Medicare administration, would be biased in favor of free-market solutions to the problems of the Medicare population, and would (so they say) actively avoid the complex and difficult regulations so favored by current administrators. So what the Gekkonians
have done is to fashion a drug plan that appears A veto would allow the Gekkonians to claim that they were the first to come up with a viable Medicare drug plan, and that the Clinton-Gore administration vetoed it out of spite. And what you're left with, elderly citizenry, thanks to Clinton-Gore, is squat. What the Clintonians are up to The Clintonians thought they had this issue sewn up. The groundwork for whipping up public sentiment in favor of a new entitlement for Medicare patients had been carefully laid. And when the proposal was made (not, to be sure, as something to be accomplished this year - but instead as a campaign issue, as a promise, as a reason for voting Clintonians into office), they fully expected to see the Quayleian, deer-in-the-headlights reaction from their Gekkonian rivals. It was meant to be a sure winner. A trump card. This is why the Clintonians have reacted so violently against the GOP response. When one thinks about it, now that the Gekkonians have embraced the notion of a Medicare drug benefit, all that's left to fight over is how much to spend, and how to administer it. The chief philosophical obstacle has been breached. If the Clintonians' chief concern was actually to provide a drug benefit, they should be celebrating. The Clintonians' violent reaction to the Republican legislation (the 10 hours of acrimonious debate, storming out of the House chamber en masse - a la the impeachment debates, promises to veto the GOP plan for reasons of terminal insufficiency) is a dead giveaway. Their reaction clearly reveals that their proposal for a Medicare drug benefit was primarily a political maneuver, and not a deeply held conviction. The Clintonians are now left in the unenviable position of having to convince their elderly constituents - whose appetites are now fully whetted for prescription drug relief this year, and not in some distant future - that the GOP plan is so awful that no drug plan is better than the GOP plan. The prospect of actually having to veto a new drug entitlement for the elderly has got to make the Clintonians sweat. The game, of course, isn't over for the Clintonians. They have shown a remarkable capability to sway public opinion by couching political issues in their own terms, and they are certainly capable of doing the same thing here. But their real hope is that the Republicans in the Senate will block this legislation. Senate Republicans have, so far, been remarkably silent on the issue. If they see the drug benefit more in philosophical terms than in political terms, they are likely to stop the legislation in its tracks. But the prospect of seeing the Clintonians hoisted on their own petard may be too much even for them. And for once, the Clintonians have lost the initiative on a health care issue. For now, they can only react.
07/1/2000
YourDoctorintheFamily.com Home Page
|
no prescription needed online pharmacy | Copyright, 2000 YourDoctorintheFamily.com and its licensors. All rights reserved