Federal lawmakers faced almost unprecedented political pressure
to support last year's legislative main event: adding a
prescription drug benefit to the outmoded Medicare health program
for our nation's seniors.
The pressure came not only from the highest levels of Congress and
even the White House but eventually from the entire Washington
system -- hundreds of sophisticated and resourceful lobbyists,
trade associations, teams of public relations experts. It carried
with it the full and formidable support of the AARP. It was the
legislative equivalent of a D-Day operation, and it was a marvel to
behold.
But despite all this pressure, enough lawmakers took a hard look
at the legislation, contemplating whether it contained sufficient
reforms and improvements to justify the largest expansion of a
Great Society program ever, to turn the vote on final passage into
a dramatic and extended staring contest. Eventually, after the
House leadership held open the voting for an unprecedented three
hours, it passed by two votes.
One wonders if it would have passed had lawmakers known then what
they know now. Namely, that it won't cost $395 billion over the
next decade as promised but closer to $534 billion, according to
updated figures from the enthusiastic backers at the White House.
Do we hear $600 billion? Or $700 billion?
Those of us who studied the progress of this legislation and who
are acquainted with the pitiful track record of official government
cost estimates for health programs weren't the least bit surprised
by the revised numbers. We warned anyone who would listen that a
bill that gives a blanket, government-designed benefit to every
senior, regardless of need -- as opposed to helping bring targeted
relief, provided through the private sector, to the 22 percent of
seniors who have no drug coverage -- would prove
unaffordable.
Medicare needs a makeover, particularly considering the Category 5
demographic hurricane headed its way in 2011 when the first of the
77 million baby boomers begin to retire. The problem could
overwhelm the next generation, and the new law did nothing but make
things worse.
Jagadeesh Gokhale of the American Enterprise Institute calculates
that the new prescription drug benefit has escalated the cost of
promised Social Security and Medicare benefits -- for which there
is no funding source -- to more than $50 trillion. That's $60,000
of debt for every child born in America today.
No sweat, say some lawmakers. In fact, before the drug bill even
passed, Sen. Edward M. Kennedy, a Massachusetts Democrat, called it
merely a first step. "When we get this as a down payment," he told
CNN, "we're going to come back again and again and again."
But some lawmakers were deeply disturbed.
New Hampshire Republican Sen. Judd Gregg said it was "incredibly
unfair for one generation to use our political clout because we are
in office to benefit" themselves at the expense of their children
and grandchildren. He correctly labeled the new Medicare bill the
"largest intergenerational tax increase in the history of this
country" and predicted -- probably with equal accuracy -- that the
new law will "cause our children and our children's children to
have a lower quality of life than we have had."
In addition to the intergenerational fiscal consequences, the
seniors who purportedly stand to gain the most may find the new
law, ironically enough, stingy. Princeton University's Paul Starr
observes that Medicare's new private prescription plans will cover
only certain drugs in every category. "What," he asks, "if the drug
you need falls outside the list? Too bad for you. Your expenses for
those drugs won't even count toward meeting your cost-sharing
requirement."
Pondering Medicare's quandary, Howard Gleckman of Business Week
magazine speculates that "either seniors will have to pay lots
more, taxes will rise, or care will have to be rationed." Sadly,
the situation could become so dire that a future generation of
policymakers may be tempted to consider the unthinkable: all three
of those options.
First appeared in the Baltimore Sun.