The soaring cost of healthcare is shaping up as the top issue in this fall's election especially if Congress fails to do anything about it.
That's why both parties are scrambling to firm up plans to help Americans pay their fast-rising tab for prescription drugs. Consumers will spend $135 billion on such medications this year, up 18 percent from 2001.
For seniors, the climbing costs can force a choice between prescriptions and food or keeping a home. For some lawmakers, it may determine whether or not they keep their seats.
Prescription-drug costs were one of the top issues on voters' minds in the 2000 presidential race, and both major-party candidates pledged to deal with it. Then came Sept. 11 and a war on terror that has occupied much of official Washington since.
The fact that the issue is being resurrected now by both parties despite the big hole it will punch in a federal budget that has already lost the surplus it enjoyed in 2000 shows that the issue has lost none of its currency.
The path from bills to a final law will surely be complicated by election-year politics. But some prominent figures in both parties have expressed optimism about its prospects.
"Republicans are desperate to inoculate themselves on prescription drugs," because of the issue's importance to senior voters, says Marshall Wittman, congressional analyst at the Hudson Institute here. "But they want to do it on the cheap.... Not only can't seniors afford prescription drugs, but Congress can't afford to pay for the benefit."
In the House, Republicans are still wrangling behind the scenes on the final shape of a proposal expected as early as today. In early drafts, the $350 billion plan called on government to pick up all individual drug costs above $5,000 a year. It left seniors, under Medicare, paying about 70 percent of their costs up to $2,000, and all costs in between $2,000 and $5,000.
In the Senate, Democrats Bob Graham of Florida and Zell Miller of Georgia are proposing a bill that that covers half the cost of prescription drugs up to $4,000, and all costs above that. It adds about $25 a month to senior's premiums, compared with $37 a month in the House GOP plan.
Debbie Stabenow (D) of Michigan, who heads the Senate's new task force on prescription drugs, is cosponsoring a bill making it easier to buy drugs in Canada, where prescription medications are 60 percent less expensive.
Some Republicans worry that their plan won't be enough to satisfy constituents and that Democrats will walk away with the issue in November. As a result, the forthcoming GOP plan ratchets up federal payments, including complete coverage for seniors living below 150 percent of the poverty level.
Others in the GOP have a different worry: that even limited drug-cost relief will bust federal budgets well into the future and make the Medicare system less viable."Solvency is always a concern when you add a new entitlement," says Christin Tinsworth, a House Ways and Means Committee spokesman.
Moreover, with a $1.35 trillion tax cut, a new $180 billion farm bill, and the biggest defense buildup in 20 years, many GOP backbenchers may find themselves on the defensive this fall on the question of fiscal responsibility.
The political theatrics are already beginning. In a unity rally on the Capitol steps on Wednesday, Democrats promised to reduce the cost of prescription drugs as part of a focus on "securing America's future for all our families."
Meanwhile, industry groups are launching new series of ads, targeted at swing lawmakers.
This week, Democratic National Committee chairman Terry McAuliffe blasted the United Seniors Association's $3 million television ad campaign supporting the GOP prescription-drug plan as "just another drug industry lobby" that is using a senior front group to "try to gain credibility" on this issue.
Democrats also point to drug companies spending on ads.
"Many are spending ... two to three times as much on advertising as they do on research," says Sen. Richard Durbin (D) of Illinois. The result is to create "false need and demand" and drive the cost of drugs ever higher, he adds.
When Medicare was first created, it included no funding for prescription drugs, which were then not a major part of medical treatment. Now 2 in 3 visits to physicians involve medication therapy, according to the National Center for Health Statistics.
Critics say the GOP plan relies too much on private-sector health insurance, which they say is sure to be very expensive and not always available, especially to poor families or those with serious health problems.
While the two sides differ in approach, consensus has been growing that the system needs fixing. Since 1997, when Medicare recipients were offered a limited drug benefit, pharmaceutical costs have increased dramatically, while the drug coverage has been capped at increasingly lower limits, according to a new study released yesterday by Families USA, a public interest group.
Meanwhile, industry spokesmen worry that Washington's assault on higher health costs could result in new mandates and lawsuits that drive the cost of health care even higher.
"Some of our members are seeing their premiums increase 30 percent to 50 percent in a year," says Bruce Josten of the US Chamber of Commerce.