BC-SENATE-DRUGS:PJ
For years, they have heard about the high cost of prescription drugs. They cite horror stories about people buying pills instead of groceries, and people paying for medication instead of heating bills.

Members of Rhode Island's congressional delegation say the cost of prescription drugs is the one issue they hear about over and over again from a core constituency: elderly voters.

Yet, Democrats and Republicans are so far apart on what kind of prescription-drug benefit to create that elderly people could again go without any help this year.

This week, the Senate is expected to take up a Democrat-backed plan that would expand Medicare to cover prescription drugs. A Republican plan, passed last month in the House, would give subsidies to insurance companies to extend drug coverage to the elderly.

Prescription-drug benefits are a perennial issue in Washington. But the debate has become heated this election year, as each party accuses the other of political posturing without having any real intention of passing feasible legislation.

"If we are going to do it, we should do it right," said Sen. Jack Reed, a Democrat who supports his party's plan.

Reed said the Democrats' plan would guarantee drug coverage by incorporating the benefit into Medicare. Subscribers would pay a $25 monthly premium with no yearly deductible.

Under the plan, elderly people would have to pay a $10 co-payment per prescription for generic drugs; $40 for preferred brand-name drugs and $60 for nonpreferred brand-name drugs. Subscribers would pay a $25 monthly premium with no yearly deductible.

The Republican plan passed by the House includes a $33 monthly premium and a $250 yearly deductible. It covers 80 percent of drug costs from $251 to $1,000 and 50 percent of the next $1,000. After that, people must then pay all costs until they reach a $3,700 annual cap.

Reed criticized the Republican plan on two levels. He said it does not guarantee coverage because it relies on private insurers to voluntarily provide the benefits. Second, there's a significant gap in the coverage for people who spend between $2,000 and $3,700 he said.

"It's idiotic," Reed said. "The people who need the coverage the most are not getting it."

Republican Lincoln D. Chafee favors an alternative plan, which would assign different deductibles and co-payments for people with different income levels. Chafee said he was still working out the details of the bill, which he plans to introduce with a group of other moderate Republicans and possibly some Democrats, he said.

His main concern with the Democrats' plan is the cost - about $400 billion to $450 billion over 10 years. Chafee wants to budget $300 billion for his plan over the same period.

"There are a lot of smoke-and-mirrors promises we can't pay for," Chafee said. "We have to be honest, there is a lot of pressure on our budget. We have to be honest under these circumstances."

The Republican plan in the House is supposed to cost about $320 billion over 10 years.

In this debate, there are key philosophical differences about how government should dole out benefits. GOP leaders say it should be done through private insurers. The Democrats say it should be achieved through Medicare.

"I have a hard time believing insurers are going to pay for this out of the goodness of their heart," said U.S. Rep. James R. Langevin.

Placing all beneficiaries in Medicare would create a massive pool of consumers. This pool would have collective bargaining power to negotiate lower prices with the pharmaceutical companies, said Langevin, who is running for a second term.

One of Langevin's opponents, Republican Rodney D. Driver, of Richmond, said Congress is too quick to provide prescription benefits without working to control costs. Driver said he doesn't have a specific plan in mind, but he would like to combine a benefit with cost-control measures.

For example, he said pharmaceutical companies should not be allowed tax breaks for TV advertising used to promote their medicines.

"Let's go after the source of the problem," Driver said. "We need some creative ideas rather than taxpayers paying for the drug costs."

Endorsed Republican John O. Matson, of Hopkinton, said he supports the House plan, but had not studied the bill enough to comment on the specifics.

Bob Tingle, Reed's Republican opponent, said he does not favor expanding Medicare to cover drug costs. "The government should not be in the health-care business," he said. "It should be left to the private sector."

On average, a person enrolled in Medicare spent $2,150 last year on prescription drugs, according to the AARP. About $860 of that money was paid out-of-pocket.

As Congress continues to debate the issue, the spending on drugs continues to rise by about 10 percent every year, the AARP says.

U.S. Rep. Patrick J. Kennedy said he believes the pressure is on the Republicans to support the Democrats' plan, if and when the House and Senate confer on the issue. Kennedy said the public has lost confidence in the private sector, after the rash of corporate scandals, and would not trust private insurers with the drug benefits.

"Their plan hardly passes the laugh test," Kennedy said. "The notion that the private sector is going to underwrite the risk flies in the face of 40 years of Medicare."

Both Kennedy and Langevin supported a bill in the House, similar to the Democrats' plan in the Senate.

Kennedy's field of aspiring Republican opponents last week also weighed in on the issue.

Christine C. Ferguson, the former state director of human services, said the debate has become narrow and bitterly partisan.

"They want to point their finger at the other party and say those terrible Republicans, they don't care about you; those terrible Democrats, they don't care about you," she said. "That's the extent of the debate."

Ferguson said neither party is focusing on the "bigger picture;" looking for ways to cut the cost of drugs by helping drug companies offset the costs of research and changing patent laws.

"They are only looking at the benefits package," she said.

Candidate David Rogers said the Republican plan, passed by the House, is fiscally responsible. He supports the idea of allowing private insurers to distribute the benefits.

And Rogers criticized the Democratic plan as being so costly that even the Democrats know it's not feasible. Although Democrats criticize the shortfalls in the Republican plan, Rogers said, "at least it represents a step in the right direction. You can't vote against legislation and be a friend of the seniors."

Mike Battles, the endorsed Republican running against Kennedy, was not available for comment for this story.

The AARP is skeptical that Congress will pass a prescription-drug benefit this year.

While the organization supports provisions in the Senate Democrats' plan, AARP officials fear the gulf between Democrats and Republicans is too large to reconcile.

"The odds are against this happening," said David Certner, director of federal affairs at AARP in Washington, D.C. "It's seems like a strange thing to say, because this is such a huge priority, but this is going to be an uphill fight."

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(c) 2002, The Providence Journal.

Distributed by Knight Ridder/Tribune Information Services.
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