Tough Medicare choices for Congress

This week Congress revives a decade-old battle over Medicare and prescription drugs, as President Bush and the Republicans try to leverage enough votes to pass the largest benefits increase in the program's history.

Call it the politics of the local pharmacy. With prescription-drug costs expected to jump by nearly $2 trillion in 10 years, more and more seniors - America's most consistent voters - struggle with how to pay the bill.

It's good politics to say government will help. For the past two election cycles, seniors have been a near-ubiquitous prop in political campaigns in both parties, and Democratic presidential hopefuls are already highlighting Medicare as a lead issue in the 2004. They even use the same formula to describe the problem: No one should be forced to choose between rent or food and prescription drugs.

"It's big," says John Zogby of the polling firm Zogby International. "Healthcare now shows up as No. 3 in terms of issues nationwide, and a lot closer now to [No. 2] terrorism and [No. 1] the economy."

Three times Republicans have muscled their version of a solution through the House, only to see it flounder in the Senate. This time, they say, will be different.

"We have a triad of possibilities: [Speaker] Dennis Hastert, who has pushed this issue for years; a senator [new majority leader Bill Frist] who has held a beating heart in his hand, and a president who will make this his No. 1 priority when he gets back from the Middle East," says Paul Jacobson, a spokesman for Senator Frist, a leading heart and lung surgeon in private life.

But with the number of seniors in the United States set to double over the next 30 years, it will be a challenge to add the single largest benefit increase in the history of Medicare, which was enacted in 1965 to provide health care for seniors and people with disabilities. Experts say it will accelerate the collapse of the system, as the number of workers paying into the system drops from 7 to 2.9 per retiree.

This demographic bind is straining health systems across the industrialized world. In Britain, the ruling Labor Party is considering requiring (or strongly urging) people to quit smoking, eat more veggies, and commit to an exercise routine as a condition for receiving government health benefits, according to British press reports. But it's unclear whether such government mandates will lower the demand for prescription drugs. "There are good reasons to do such things, but it's unclear whether that is doing a favor to the people paying the bills," says Gary Burtless, a senior fellow at the Brookings Institution in Washington.

"The reason that people in most other rich industrial countries do not spend as much on drugs as Americans do is because there is stiff negotiation between the government and the drug manufacturers," he adds.

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