Uncle Sam's club

November 26, 2003

IN DECIDING whether to cheer that Congress has finally added a prescription drug benefit to Medicare, it should be helpful that lawmakers on the far left and far right hate the legislation about equally. Generally, that's a sign of a compromise in the center, and a well-balanced approach.

This deal, though, even 15 years in the making, was not quite ripe. Most troubling is that the only people really happy with it -- apart from President Bush and other GOP leaders who have pulled off a major political victory -- are the drug industry lobbyists who get to expand their market with no curbs on costs.

Burning AARP membership cards in protest only adds to the smog. Instead, older Americans, whose voting clout is the prize at the end of this brutal struggle, should demand that backers of the legislation live up to their grand promises of delivering much-needed relief. There's still plenty of time before next year's elections to correct the bill's shortcomings.

Make no mistake, the Medicare measure represents a huge step. It is the first major expansion of one of Lyndon Johnson's treasured Great Society programs; henceforth, the federal government will guarantee the elderly help with buying outpatient medications. That limitless financial commitment is the reason House GOP deficit hawks had to be bludgeoned into supporting it.

At the same time, the legislation makes small, tentative moves to encourage Medicare beneficiaries into managed care insurance plans that could more efficiently direct medical resources than the current fee-for-service approach.

So, while providing a new, if initially quite skimpy, benefit, the measure also seeks to shift to beneficiaries, particularly the affluent, a greater share of medical costs.

The bill's major flaw, which requires immediate repair work, is that it does nothing to curb the burgeoning growth of those medical costs. Instead, it increases payments to providers, offers generous subsidies to insurance companies to entice them into the Medicare market and actually prohibits the federal government from using its purchasing power to negotiate discounts on drugs.

Health and Human Services Secretary Tommy G. Thompson, who struck a bargain with Bayer during the 2001 anthrax scare for a markdown on Cipro, suggested over the weekend that Congress could vote next year to reinstate and expand his negotiating authority.

The lawmakers ought to leap on the suggestion -- and be ready to make any other course corrections required as the Medicare restructuring gets under way. Just to be sure, current and future beneficiaries should be standing by with a cattle prod.

It's no mystery why the politics of pleasing the elderly have become a blood sport. Voters can use that power to make sure that if Sam's Club doesn't have to pay retail, Uncle's Sam's club doesn't either.

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