A year ago, both parties in Congress finally agreed on the principle - if not the details - of adding a prescription drug benefit to Medicare.
But ah, those pesky details. Despite the consensus and strong public backing for a sure-winner issue, a plan has yet to be enacted. And as Congress returns to the issue this week, the sides seem far apart. They should work toward a balanced plan that doesn't commit Washington to a blank-check program costing trillions over the long-term, but also doesn't give away the store to insurance firms.
Both houses passed benefit bills that would cost roughly $400 billion over 10 years, but with vastly different details that must be reconciled. It is complex legislation that combines existing plans with new ones, private initiatives with public ones.
At issue, basically, are how much the government will control it, and how many people will be covered. Republicans want a more limited-scope benefit with a push toward privatizing and competition. Democrats want a government-run program that brings all the nation's seniors into its net.
This week, lawmakers may fight over "affluence testing" to make upper-income seniors pay more for benefits. Testing is considered the fairest way to control Medicare costs.
But when Sens. Dianne Feinstein, D-Calif., and Don Nickles, R-Okla., made it a bipartisan amendment, Sen. Edward Kennedy, D-Mass., said he'd filibuster the entire bill. "You can have this amendment or you can have this bill - but you can't have both," said Kennedy, who rails against "tax cuts for the wealthy" but doesn't mind if they get government subsidies. The amendment died.
Adding a drug benefit is the right thing to do, especially for lower-income seniors devastated by medical costs. But at $227 billion a year, Medicare is already the second-biggest federal program. We can't afford to let it balloon out of control.
Insurance companies are exerting pressure, too, lobbying Congress to pay them more for administering Medicare plans and essentially guaranteeing them a profit margin.
As House Speaker Dennis Hastert, R-Ill, said, "This is one of the more complicated bills that we've had probably before the Congress in a decade, and we need to do it right. We need to take our time." Exactly.
About the plan
Some features of the plan passed by the House:
After a $250 deductible, the benefit would cover 80 percent of the next $1,750 a year in drug costs for a $30-a-month premium.
It would pay 100 percent of all drug costs over $3,500 a year.
Low-income seniors (about 30 percent of all seniors) would have all prescription costs covered, paying a minimal co-pay, but no monthly premiums or deductibles.
Seniors get an immediate 25 percent reduction with a prescription drug discount card.
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