Drug costs seize voters' attention

Gore and Bush offer dueling proposals to ease seniors' pain

September 20, 2000|By Jonathan Weisman | Jonathan Weisman,SUN NATIONAL STAFF

CLEVELAND - It has been seven difficult years since Barbara Wulff's mother was stricken with Alzheimer's disease, seven years of searching for the right caregivers - and of paying prescription drug costs as high as $800 a month.

Wulff is not political, she said, certainly not a partisan of one party or another. But this election season, she is painfully aware of one issue that could decide her vote in November: the cost of her mother's medication.

"By the time we pay $4,000 a month for her care, another $800 for her medication, that's a serious chunk of change," sighed Wulff, a computer programmer from Uniontown, Ohio.

In a presidential election that once appeared bereft of a burning issue, the question of soaring drug prices for seniors has emerged front and center. Only a fraction of the 49 million people on Medicare completely lack coverage for prescriptions, but the power of the issue extends well beyond those 12 million seniors.

It has struck a chord among seniors who worry about the future of their insurance plans, and among millions of aging baby boomers who are caring for elderly parents and looking with trepidation toward their own retirement.

By 2002, the number of seniors with no drug coverage will likely rise from about a third to about 40 percent, as private insurers drop such coverage or leave Medicare altogether, according to the Congressional Budget Office.

And those who keep their drug coverage will likely pay higher deductibles or co-payments. The median drug bill for seniors is close to $100 a month, and rising by 15 percent a year, said John C. Rother, director of legislation and public policy at the American Association of Retired Persons.

"For people who are not well-insured, this is the No. 1 issue," Rother said, "an observation borne out by interviews with seniors in the suburbs of Cleveland and Akron.

Ohio will be a critical state on Election Day, especially for Gov. George W. Bush. No Republican has ever won the presidency without carrying Ohio, which was once solidly in Bush's camp but is now up for grabs.

Both Bush and Vice President Al Gore have proposals to expand prescription drug coverage. And both would spend considerable federal dollars: $338 billion over 10 years under the Gore plan, $148 billion under Bush's.

But for Bush, it may not be enough to simply present a proposal to an electorate inclined to trust Democrats on health-care issues. In many ways, Bush's plan to add a prescription drug benefit to Medicare by injecting more private competition is bolder than Gore's more conventional approach - and the one that holds out the prospect of a long-term fix for the beleaguered system.

But the Republican candidate must battle the perception among seniors that Gore's plan is more generous and less restrictive.

"I think [the Bush proposal] is fine," said a prominent Republican health-care consultant who spoke on condition of anonymity. "It's not gangbusters. It's not something that's going to completely neutralize the issue, but it's a step in the right direction. And it's going to take a lot more work. For a Republican on this kind of issue, it always does."

Seniors in the suburbs of Cleveland illustrate this problem. Even the most ardent Bush supporters do not know the essence of what the Texas governor is proposing.

Bush is "just throwing out sops to us oldsters," said Dave Wible, 84, a staunch Republican living in an upscale retirement community in Hudson, Ohio.

Seniors see Bush's plan as more selective in whom it will cover, more dependent on HMOs and less likely to offer choices.

"I don't want to be told what doctor I should go to," said Eunice Radike, 81, a lifelong Republican from Parma Heights who plans to vote for Gore. "With Bush's plan, it sounds like you're going to be told."

Bush does not have a plan so much as a "framework," suggested Charles N. Kahn III, president of the Health Insurance Association of America, which represents small insurance companies.

The Bush plan has two parts.

The first - block grants to the states totaling $48 billion - is intended to extend coverage to poor seniors as quickly as possible. States could offer drug coverage through Blue Cross, through an expansion of Medicaid or through their own programs.

Seniors who earn $11,300 or less, and couples with incomes of $15,200 or less, would have their drug bills completely paid by the government. But for those with higher incomes, the government would pay no more than 25 percent of the total drug bills.

This temporary plan would be replaced in 2005 with an overhaul of the entire Medicare system. Though the details must be worked out, Bush envisions private insurers competing for the 39 million seniors now in Medicare. Seniors could choose one of those private plans, or keep Medicare's existing fee-for-service coverage.

Gore would spend more than twice as much money and simply add an optional drug benefit to the existing Medicare program.

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