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The Bush administration is pulling-off a $400 billion Medicare bill that contains provisions for prescription drug benefits, with a vote
expected today in the Senate.
Washington watchers say it is a done deal.
The passage of the bill could be a major plus toward George Bush being re-elected.
The bill contains free-enterprise conditions to the government-run Medicare program, repelling attacks by die-hard
Democratic opponents.
The Democrats say the bill opens the door to privatize the system. It will add a prescription drug benefit, provide billions of
dollars in subsidies to insurance companies and HMOs, and take the first step in allowing private plans to compete with
Medicare.
It is the largest expansion of Medicare since the program was created in 1965.
Most Republican supporters say the bill would help lead to better private coverage for seniors. Opponents say it would
waste taxpayer funds and effectively force seniors into inadequate and expensive health plans.
Some conservative Republicans oppose it, arguing it is far too expensive, particularly in light of the current economy. Sen.
Judd Gregg (Republican) of New Hampshire called the bill "a massive tax increase being placed on working young
Americans and Americans who haven't yet been born, in order to support a drug benefit for retired Americans and
Americans who are about to retire."
Democratic Sen. Edward Kennedy said "It's the first step toward a total dismantling of Medicare. In exchange for
destroying Medicare, it offers senior citizens a paltry and inadequate drug benefit. And the moment it is implemented, it will
make nine million senior citizens ... almost a quarter of all senior citizens, worse off than they are today."
Most Republicans have been supportive of privatizing both Medicare and Social Security. Opponents of the bill say this
is the first step.
Sen. Robert C. Byrd said "The Congress should be fashioning a real prescription drug
benefit. That is what the American people have been told we are
doing. Instead, the Congress debates a major restructuring and a
step toward the privatization of Medicare. It is a debate that has
largely been hidden from the public. A debate that our nation's
seniors did not ask for."
Instead of the AARP lobbying the Bush administration, the Bush administration has listened to the AARP and has carefully
crafted a bill that appeals to the lobby group and numerous other groups that have generally been luke warm.
Byrd complained the conference report was hatched behind closed
doors. "Some have asserted this legislation is merely a Trojan horse
designed to get rid of Medicare," said Byrd. "I hope that that is not true. But
there is something awfully suspicious about this particular horse
that is galloping through the Congress."
One of several items that sweetens the pot on Medicare reform, is a proposal to spend $25 billion more on rural doctors,
hospitals and health providers, the largest boost for rural health care in years.
"This is the best thing rural America has ever seen," said Iowa Sen. Charles Grassley, one of the bill's principle
authors.
The measure eliminates what some groups claim are long-standing disparities between rural and urban health care.
Depending on who you ask, there has been a real problem of access and inequity for patients and their providers in rural
areas.
The disparities also make it difficult for rural hospitals to attract new physicians, said Steven Summer of the West Virginia
Hospital Association.
In seeking physicians, hospitals aren't simply competing in their own rural area. Instead, they are pitted against larger urban
and suburban facilities that often can afford to pay more.
"One of the reasons we have been losing doctors in West Virginia is because of the poor reimbursement rates from
Medicare," said Republican Rep. Shelley Moore Capito, a supporter of the bill.
About 201,685 of the 340,000 older and disabled West Virginians who are enrolled in Medicare are rural residents,
according to Families USA, a health care advocacy group. However, a pair of recent studies argue that rural Medicare
recipients and their urban counterparts have similar access to care.
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