Prescription drug coverage was supposed to be just what the doctor ordered
for Democrats in 2002. The party had a comprehensive plan endorsed by
Democrats across the political spectrum -- from Sen. Zell Miller of
Georgia to the late Sen. Paul Wellstone of Minnesota. The House Republican
plan looked more like Swiss cheese than a real drug benefit.
But it was no magic pill. Instead of enjoying victories in the House
and Senate, Democrats lost control of both chambers. In the process, they
even lost the senior vote.
Republicans were disciplined in their efforts to blur the differences
between their proposals and the Democratic plan. They banked on the fact
that Americans aren't bean counters and that a fight over deductibles
and so-called "doughnut holes" -- or gaps in coverage -- would
be too hard to follow. They jammed their flawed plan through the House.
When the Senate couldn't pass a plan, Republicans were ready to pounce,
accusing Democrats of pandering to seniors, not offering real solutions.
And now that Republicans have control of the whole government, there is
little question that they will try to co-opt the prescription drug issue
for the next two years.
Democrats need to be ready with a new plan. Here's what they should do:
First, don't try to win a bidding war. Democrats almost never win a fight
over dollars, because all voters tend to hear is the reflexive demands
of big-spending liberals. Crying out that $350 billion is inadequate not
only sounds ludicrous outside Washington, it rings hollow in a sputtering
economy with growing deficits.
Second, don't pit the party against the innovation promised by drugs.
Drugs are a critical and growing part of health care, especially for people
with chronic illnesses, which afflict three-fourths of all Medicare beneficiaries.
Instead, the real fight Democrats should wage is over the cost of drugs.
The key is to ensure that beneficiaries and taxpayers get the best value
from a drug benefit. Every year it becomes harder for the country to afford
a Medicare drug benefit because prescription drug costs are soaring at
double-digit rates. A comprehensive benefit with no gap and a reasonable
premium is likely to cost about $1 trillion. If Democrats continue to
try to win this issue through a bidding war, the price tag will become
the central object of criticism -- and a valid one at that.
Moreover, Democrats have important and powerful allies on the cost issue.
Holding down drug costs will not only help seniors who lack drug coverage
but also provide relief to employers, employees, states, and insurers
who are feeling the pain of rising costs.
Of course, the cost issue will only work for Democrats if they offer
real answers. Price controls won't work. But restoring the principles
of genuine competition and fiscal responsibility to the drug debate will
be good for consumers and businesses alike.
Last year, the Senate passed legislation to bring more affordable generic
drugs to the market. House Republicans and the Bush administration opposed
that effort, resorting to a half-baked regulatory fix designed to give
Republicans political cover. With the potential for saving as much as
$60 billion, the push on generics should continue to be a centerpiece
of the Democratic agenda.
However, more can be done. Many states are desperately trying to improve
the price Medicaid pays for drugs. In fact, even states under conservative
leaders like Florida Gov. Jeb Bush have taken steps to hold down drug
prices. Democrats should adopt the best cost-cutting models. This will
not only reduce costs for beneficiaries and taxpayers, it will force Republicans
to show whether they have a plan to hold down costs.
At the same time, Democrats should stop promising the moon on prescription
drugs. They should set their sights on a reasonable, achievable benefit.
Last year, New Democrats offered an alternative that would have provided
all seniors a discount on every trip to the pharmacy and ensured that
no senior's savings were wiped out by drug costs. It would have limited
annual drug costs to $4,000 and provided comprehensive coverage to low-income
seniors. This approach contained no additional premiums for beneficiaries,
so every senior would come out ahead.
Finally, Democrats should remember that misuse of prescription drugs
is a big problem among seniors. Many are overmedicated because no single
doctor is coordinating their care. In addition, everyone is at risk when
a pharmacist misreads a doctor's handwriting and when no one checks to
see whether the mixture of medications prescribed by different doctors
is dangerous.
A robust cost-cutting and quality-improving agenda -- combined with
a reasonable prescription drug benefit run though Medicare -- would
give Democrats a plan to hold down health care costs and offer real help.
That's a prescription that could help us all get well.
