Lay in a supply of Pepcid. The chefs in Washington are cooking up a Medicare hash, and you can count on severe indigestion after they serve up this concoction.
The Medicare prescription drug benefit legislation now rolling through the halls of Congress is a sequel to the tax cut bills that President Bush and lawmakers have produced. Like most such efforts, the new measure lacks some of the creativity of the originals. You would have to work hard to achieve the special effects of the tax cut packages, with levies that expire or are placed in suspended animation, then are reborn and perish again as the treasury grasps for revenue targets that are as artificial as a computer-generated "Star Wars" character.
Give these guys credit for trying, however. As the solons scramble to unload a dish on the nation by the July 4 recess, they are assembling a machine that rivals the tax bills in Rube Goldberg-like complexity and Jerry Lewis-like zaniness.
The various House and Senate proposals are often bizarre. A bill approved by the Senate Finance Committee, for example, would charge seniors a $35 monthly premium for drug coverage and a $275 annual deductible. Medicare then would cover half a beneficiary's drug costs up to $4,500 a year. Then the patient enters a coverage limbo, where he or she must pick up the tab for costs between $4,501 and $5,800. Suddenly, for reasons that surely will seem mysterious to seniors, coverage resumes when the patient's bills exceed $5,800 a year, kicking in at 90% of additional costs.
Medicare recipients aren't the only group victimized by such practical jokes. A House GOP plan, in a robbing-Peter-to-pay-Paul scenario, would slice into hospitals' inflation adjustment to fund this program. History suggests this would be the first of several such cost shifts. Congress has set aside $400 billion for Medicare changes but it is hard to see how Washington will subsidize all its promises in a slumping economy and a time of massive tax cuts and military spending.
And managed-care companies, who complain they were shortchanged on Medicare HMO payments, are expected to jump into drug coverage.
The key ingredients in this wacky stew are politics, ideology and misplaced priorities. Democrats and Republicans want to show voters that they finally delivered on the long-debated drug benefit ahead of the 2004 elections. Sen. Edward Kennedy (D-Mass.) wants fellow liberal Democrats to accept half a very expensive loaf and declare victory in the battle for expansion of benefits. He undoubtedly figures that a benefit once bestowed will not be rescinded. (Perhaps the senator doesn't remember the photos of an irate senior citizen riding the hood of Dan Rostenkowski's car in protest over the Medicare catastrophic benefits law of the late 1980s.)
President Bush-the most ideological chief executive of the past 50 years-is willing to accept a watered-down scheme to nudge seniors into private health plans. The Bush administration will not rest until it financially starves public social programs and privatizes all three branches of government.
To top off this devilish cake, lawmakers are setting the timer so the benefits won't be ready until 2006. That will give them and Bush more than two years to avoid the consequences of their ill-conceived actions.
All of this is good politics and bad policy. Future presidents and congresses will be fixing the mistakes in this package for the next decade. Even congressional aides are acknowledging that unpleasant prospect is a near certainty.
If Bush and Congress were serious about helping those who need help, they would go back to the kitchen and whip up a logical and workable plan for providing drug coverage to low-income seniors. If they can't do that, they should just stay out of the kitchen.
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