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2003-11-25 -- Bush Poised To Claim Victory

Thanks for PNHP's Don McCanne for this:

The Washington Post November 25, 2003

By David S. Broder and Ceci Connolly

... President Bush has made a bid to break the historic political
alliance between Democrats and senior citizens -- a feat that could
change the dynamics of next year's election and perhaps long-term
partisan patterns in this country.

... the White House was poised last night to claim credit for the
measure, which would begin subsidizing seniors' drug bills in 2006 and
at the same time move Medicare from a purely governmental program to
one with a major role for private insurers.

Thomas E. Mann, a Brookings Institution authority on Congress, said
enactment of the legislation "is not the end of the story, but the
beginning of a great political struggle to define its meaning."

... this promises to be an intensely partisan issue in next year's
election.

http://www.washingtonpost.com/wp-dyn/articles/A11573-2003Nov24.html


Don McCanne's Comment: By now you know that the Medicare bill passed
the Senate by a vote of 54 to 44. All that remains is the ceremony
with a gloating President Bush signing the bill.

The process leading to this bill was characterized by one of the
greatest lapses in the ethics of politics in the history of Congress.
The American people wanted a prescription benefit for Medicare. The
politicians in control of the process didn't want any more
entitlements, but they did want to dismantle Medicare as a program of
social insurance and turn it back to the marketplace. They used a
mediocre prescription benefit to extort weak politicians whose support
they needed to help break down the structural integrity of Medicare.

The egregious ethical lapse occurred in the House. The joint
conference committee meetings were held secretly, excluding even the
Democratic House members of that committee. Although promising three
days to allow time to read the 678 page bill, the House leadership
acted immediately after the release of the bill. They held the House
in session that day, and then called for a vote at 3:00 a.m. The bill
was defeated. The leadership held the vote open for an unprecedented
three hours. Once it was clear that the bill had been defeated, 16
Democrats who were concerned about the political repercussions of
"voting against prescription drugs for seniors," voted in favor of the
bill without risk of causing it to pass. HHS Secretary Tommy Thompson
came to the House floor to "work" the conservatives who had voted
against the bill. President Bush called the recalcitrant members. "The
Hammer" DeLay and House Leader Hastert intensively worked over these
members.

As a last resort, the leadership told the holdout conservatives that
if this bill were defeated, the Democrats would introduce a bill with
only the prescription entitlement which would surely pass. They failed
to point out to these jagged, sleep-deprived representatives that the
Republican leadership has total control over the bills that would be
brought to a vote, and such an entitlement would never be permitted.
This lie did it. Two votes crossed over, and then the vote count was
immediately slammed shut before the 16 Democrats could be approached
to see if they were willing to change their vote from a political vote
to a health care justice vote. Like Florida, this vote was not about
obtaining an accurate count; it was about using chicanery to obtain a
vote that gives you a victory even though it defies the will of the
slim majority. That's not good politics. That is blatant dishonesty.

This abusive political process mandates a political response. There
are three immediate actions that we can take.

First - This bill is alleged to be about making prescription drugs
affordable to Medicare beneficiaries. But the following language was
inserted into the legislation under Title I - MEDICARE PRESCRIPTION
DRUG BENEFIT.

(Page 53) - Sec. 1860D-11.  (i) NONINTERFERENCE. - In order to promote
competition under this part and in carrying out this part, the
Secretary -  (1) may not interfere with the negotiations between drug
manufacturers and pharmacies and PDP (prescription drug plan)
sponsors;and  (2) may not require a particular formulary or institute
a price structure for the reimbursement of covered part D drugs.

Physicians, hospitals, laboratories and other providers under Medicare
have their fees and prices controlled. Although the process is not
perfect and needs improvement, nevertheless it is designed to ensure a
fair profit for providers and an appropriate value for taxpayers. This
legislation prohibits the government from demanding similar value from
the pharmaceutical firms. Furthermore, it inserts the middlemen
pharmacy plan managers into the process, which will add to the
administrative costs while introducing to Medicare secret contracts
that are designed to enhance profits rather than being designed to
ensure access to appropriate drugs.

We should demand that Congress delivers on its promise of affordable
drugs. This means that government negotiation and bulk purchasing
should be instituted, and the pharmacy drug plans should be replaced
with a publicly administered prescription program.

Second - This bill is alleged to be about providing value by
introducing competition between private health plans and the
traditional fee-for-service Medicare program. But the following was
inserted into this bill under Title II - MEDICARE ADVANTAGE.

(page 196) - Sec. 221.  (e) STABILIZATION FUND. -  (1)
ESTABLISHMENT. - The Secretary shall establish under this subsection
an MA (Medicare Advantage) Regional Plan Stabilization Fund... which
shall be available for two purposes:  (A) PLAN ENTRY. - To provide
incentives to have MA regional plans offered in each MA region...  (B)
PLAN RETENTION. - To provide incentives to retain MA regional plans in
certain MA regions with below-national-average market penetration...
(2) FUNDING. -  (A) INITIAL FUNDING. -  (i) IN GENERAL. -
...$10,000,000,000...  (ii) PAYMENT FROM TRUST FUNDS. - Such amount
shall be available to the Fund, as expenditures are made from the
Fund, from the Federal Hospital Insurance Trust Fund and the Federal
Supplementary Medical Insurance Trust Fund...  (B) ADDITIONAL FUNDING
FROM SAVINGS... ... transferred into a special account in the Treasury
from the Federal Hospital Insurance Trust Fund and the Federal
Supplementary Insurance Trust Fund...

The private plans authorized by the new Medicare Advantage program are
supposed to be competitive with the traditional Medicare program. How
does $10 billion taken from the Medicare Trust Funds and given to
these private plans create a competitive model? These special
incentives should be repealed, and the plans forced to compete without
receiving these special subsidies.

Third - We should continue to demand that William Novelli resign from
AARP. The publicity over AARP will alert those who remain relatively
uninformed about the fact that this Medicare legislation is highly
flawed and needs to be changed.

There are many other measures in this legislation that need attention.
But, right now, let's demand fair prices for prescription drugs
through the regulatory process, and let's demand that private Medicare
Advantage plans be prohibited from receiving special subsidies from
our Medicare Trust Funds. Start organizing today.

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