Acme Medicare

It's always hard to watch your side take a dive. That's what happened when the Democrats buckled Nov. 24 to allow passage of Republican Medicare "reform" in the Senate.

The Medicare bill is expected to spend nearly $400 billion over the next decade, but much of that money will go to the private health industry, the first step in the process of privatizing the government health care program. The bill was supposed to help seniors obtain prescription drugs, but Republican congressional leaders made sure that the drug programs will run through private insurance companies -- and seniors won't get much help until 2006 at the earliest.

The bill was so corrupted that it prohibits the government from negotiating lower drug prices for 40 million elderly and disabled Medicare recipients. Instead it protects pharmaceutical profits. It continues the ban on buying lower-priced but identical drugs from Canadian pharmacists. (The ban is much-flouted but it's probably only a matter of time before John Ashcroft sics the DEA on senior scofflaws). As the Austin American-Statesman noted Nov. 25, "Americans already pay the highest prices in the world for prescription drugs, and this bill ensures that they will continue to do so."

A professor at George Washington University estimates that in 2006 the government will pay private plans 25% more than what it costs to cover a senior in traditional Medicare fee-for-service, the Des Moines Register noted. The bill earmarks $12 billion as an incentive to insurance companies that offer Medicare to seniors or maintain existing plans. Another $86 billion is set aside to pay employers to continue providing health benefits to retirees. "Not only will companies be paid extra to take over the health care of seniors, they can get millions more just be threatening to abandon the seniors. Companies will ask for extra dollars as an 'incentive' to offer care. More than one-fourth of a $400 billion Medicare price tag is money earmarked for bribing private industry."

Yet what seniors get out of the bill is still not entirely clear. The Register concluded, "If the country is going to add another $400 billion to the national debt, it should be spent directly to pay for health care, not to subsidize industry." We agree.

Even a $25 billion nugget that is supposed to increase reimbursements for doctors and hospitals in rural areas was jiggered to benefit states that already rank near the top of the reimbursement lists, the Register noted. Louisiana, which already ranks No. 1 in the nation for money per Medicare beneficiary, with $8,099 per senior on Medicare in 2001, would get $9,014 under the "equity measure" while Iowa would see an increase from the current $3,414 per senior to only $3,997.

The 681-page bill was worked out behind closed doors among Republican House and Senate negotiators -- nominal Democratic Sens. John Breaux of Louisiana and Max Baucus of Montana were given honorary GOP status to seal the deal. House Democrats were entirely excluded from the negotiations. The final "conference report" had such an odor that it had to be rushed to the House on Friday, Nov. 21, for debate. Still, a combination of principled Republicans and the bulk of Democrats joined to defeat it -- or so they thought -- early Saturday morning, Nov. 22. But the GOP leadership would not accept defeat. They rigged the process to keep the voting open for three hours while the errant R's were browbeaten into changing their votes to pull out a 220-215 win for the Bush White House shortly before dawn.

As Sam Uretsky writes on page 16, the bill is not better than nothing. It is a trap for the foolish and the Democrats once again played the part of Wiley Coyote, buying the Acme Medicare plan.

Sen. Ted Kennedy had urged colleagues to pass an earlier version of the drug bill in the belief that Republicans would agree to an acceptable compromise. When he got back Medicare privatization experiments, HMO subsidies and medical savings accounts, he tried to filibuster but it was too late. Majority Leader Tom Daschle opposed the filibuster, although he joined the opponents on a procedural vote that failed 61-39 and the final vote as the bill was approved 54-44.

What Democrats failed to understand, Sen. Hillary Rodham Clinton told the Washington Post's E.J. Dionne Nov. 24, is that Republicans "are on an ideological march. They have no intention of playing fair. They want what they want when they want it." And they get it.

Rep. Barney Frank, D-Mass., told Dionne there is no more legislative give-and-take. "The Republican Party in the House is the most ideologically cohesive and disciplined party in the democratic world," Frank said.

Daschle is an easy target for criticism. One columnist wished the minority leader would show his "inner Lyndon" in the Medicare fight but Lyndon has left the building -- or Majority Leader Bill Frist is channeling his ghost. But Breaux and Baucus sold out the party and there's not much Daschle can do to punish those whose allegiance to insurance and pharmaceutical companies is stronger than their loyalty to constituents.

AARP, the retiree group, also outraged many of its members when it not only signed onto the bill but put $7 million into an advertising campaign to support it. "Finally, a bill is about to be voted on," an AARP TV commercial said. "While not perfect, we know there are millions of Americans who can't afford to wait for perfect." Well, those millions will still have to wait until 2006 and then they'll find that they have to spend $3,600 out of their own pocket before the insurance picks up 95% of costs. Republicans hope that Bush will be on the downward glide of his second term by then.

AARP has a conflict of interest because of its revenues from insurance-related ventures, such as Medigap supplemental drug insurance policies and prescription drug discount cards. According to Public Citizen, AARP's royalty income from health insurance policies amounted to $107.8 million in 2002. AARP's investment income from insurance products totaled $26.7 million in 2002. AARP also derives income from a prescription drug discount card marketed to its members, which is a program that would be offered in 2004 and 2005 before the prescription drug benefit becomes available. (See the full analysis at www.citizen.org.)

Constituents who are displeased with this travesty should let their representatives and senators know when those pols come home for the holidays. Money is often a more potent motivator than doing what is right -- and the GOP has the money --  but pols fear an informed and angry electorate most of all.

Leave it to the Senate Democrats to crater on Medicare just a few days after they stood up to block the execrable GOP energy bill. So much for celebration. It appears that the D's don't want to use their spines any more than necessary.

Among other things, the energy bill, which originated with Vice President Dick Cheney's secret meetings with corporate lobbyists, would repeal the 70-year-old Public Utility Holding Company Act, which prevents anti-consumer business practices by energy companies. That's reason enough to oppose the bill, but it also would remove many environmental regulations, it would shield makers of the gasoline additive MTBE from liability lawsuits arising from contamination of underground water supplies, it would provide $25 billion in tax giveaways to energy producers.

The GOP was just two votes shy of the 60 votes needed to cut off the filibuster Nov. 21 after House Republicans pushed through the bill earlier in the week. Daschle also voted against the Democrats in favor of the energy bill, which would boost farmers by expanding the use of corn-based ethanol. The bill appears stricken for now but R's have not given up on passing it, so stiffen your senators' spines while they are home. Lord knows, we can't taken anything for granted. -- JMC

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