Kennedy Angers Allies
Supports GOP Drug Bill

June 23, 2003
Senator Edward M. Kennedy (D-Mass.) is normally the scourge of Senate Republicans. But this week, it's Democrats in the Senate and elsewhere who are miffed at the Massachusetts liberal for throwing his support behind the Republican plan to add prescription drug coverage to Medicare.

Both houses of Congress are poised to approve their versions of a Medicare drug benefit this week. While the plans differ sharply, they have one thing in common: both are mind-numbingly complex and will be difficult for seniors, their physicians and insurance companies to interpret.

Democrats and their liberal and labor union supporters say the Republican plan is inadequate and is the first phase of a GOP maneuver to turn Medicare over to private insurance companies.

Kennedy begs to differ. As he sees it, the current bill is a $400 billion down payment that can be improved and broadened as time goes by. Kennedy calls it "an opening" and says it is the only chance to enact a prescription drug benefit in this Congress.

Besides, said Kennedy in several weekend interviews, if Democrats block the measure Republicans will paint the Democrats as obstructionists and will have a stronger chance of winning more seats in the upcoming Congressional elections. By supporting the measure, Kennedy says Democrats can tell voters that they should send more Democrats to Congress to continue the fight for improved Medicare coverage.

Sen. Barbara Boxer (D-Calif.) denounced the plan during Democrats' weekend radio address. She said the measure would require too many senior to sign with private insurance companies to get the drug benefit. She charged those companies "put their dollar signs ahead of your vital signs."

Complexity

The House and Senate versions are nothing if not complex. Sen. Hillary Rodham Clinton (D-N.Y.), no stranger to complex, large-scale health care legislation, says the measure will create "a Medicare maze, a whole new bureaucracy."

For starters, seniors will face a number of decisions -- whether to stay with traditional fee-for-service Medicare or join a private plan. If they decide to join a private plan, they will have to choose among an array of companies and types of plans, including health maintenance organizations (HMO), preferred provider organizations (PPO) and hybrid plans.

Those who stay with traditional Medicare will have to buy "drug only" insurance, something that doesn't now exist on a large scale. If fewer than two private plans are offered in a given area, the government would provide a "fallback plan," under the Senate bill.

For the first time ever, different beneficiaries will pay different premiums and have different levels of coverage. Currently, most Medicare beneficiaries pay $58.70 a month and get virtually identical benefits. Under all of the measures now pending in Congress, premiums and benefits will vary widely.

Each year, just like musical chairs, everything will change, as companies revise their plans, drop some offerings or pull out of a region altogether.

There are still many competing provisions to be hammered out and each party has its sacred cows. The Republicans have agreed that the government can pay for prescription drugs but are determined that it must not control prices. Democrats, on the other hand, want Medicare to use its huge purchasing power to drive prices down.

The Republicans want to encourage PPOs to participate in Medicare, thinking they will provide services more effectively. But most PPOs have not yet been able to figure out whether they would be able to operate in the Medicare market because of the complexity of the legislation and the huge uncertainties entailed in serving a vast population of seniors, nearly all of whom have at least some chronic health conditions.

Whatever is finally enacted will, be tinkered with by Congresses and by the new federal bureaucracy that will be created to run it. Or as Drew Altman, president of the Kaiser Family Foundation put it in a New York Times interview: "The history of most great social legislation in our country ... is ready, fire, aim."

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