Prescription Drug Benefit in Medicare Opinion Editorial
submitted 09/24/03 to Scripps Howard syndicate, Washington, DC for national publication
Since the early 1990s, candidates from both political parties have promised to support federal prescription drug benefits. But, we are a few months from the start of the 2004 presidential election process and a Medicare prescription drug benefit is still under attack.
Some critics of today's pending bills in Congress for a prescription drug benefit in Medicare want Americans to believe this legislation is little more than a replay of a repealed federal catastrophic health care law from the 1980s. Some also claim that negative political consequences similar to those of the 1980s await those from both parties who support the 2003 legislation. AARP believes that such viewpoints are the result of drawing the wrong lessons from the past.
A famous warning is that those who cannot remember the past are condemned to repeat it. AARP thinks that understanding what happened surrounding the repealed federal law is essential to drawing appropriate conclusions today.
In 1987, medical doctor Otis Bowen, who had been the Republican governor of Indiana, was serving as secretary of Health and Human Services. "Doc" Bowen had grown concerned that Medicare coverage at that time was not sufficient to help older Americans from suffering financial catastrophe resulting from a serious illness. His own wife had died of cancer after lengthy hospitalization, so Dr. Bowen was not approaching public policy from a theoretical level.
During his second term, President Ronald Reagan supported the Bowen plan, but since the president insisted that the new law could neither impose new taxes nor add to the federal deficit, this meant that beneficiaries would have to pay for it. A significant and noteworthy champion of the legislation was the legendary Claude Pepper of Florida who helped ensure that the Act received strong bipartisan support. After several months of considerable wrangling and revising in Congress, a bill was ultimately sent to President Reagan, who in 1988 signed into law what was known as the Medicare Catastrophic Health Care Act.
Even though others opposed it, AARP played a prominent role in advocating on behalf of that legislation. It included a then-controversial drug benefit for those with high expenses that added significantly to the costs. The bill also included benefits that limited a patient's liability for long hospital stays or high expenses for doctors, expanded home and community-based care, protected surviving spouses from the devastating costs of long-term care, and added important prevention benefits to Medicare. The program was made mandatory in order to spread the costs widely, and was partially financed by an annual "supplemental premium," capped at $800, that was based on a beneficiary's total income.
AARP was criticized by opponents of the 1988 bill. Heated protests erupted by some better-off older Americans. One infamous protest happened in 1989. Congressman Dan Rostenkowski, who was then chairman of the House Ways and Means Committee, was caught on videotape running from an angry demonstration by older Americans in his home district of Chicago. The unusual protest culminated in a 69-year-old woman flinging herself in protest onto the hood of Rostenkowski's parked Chevrolet. The fact that no one would have been required to pay more than the cost of their Medicare benefit was not persuasive. Congress voted to repeal the bill before it ever had a chance to be implemented.
The congressional repeal meant that the debate over providing prescription drug benefits in Medicare remained relevant over the subsequent decades. However, both the context and the design of prescription drug coverage are very different in 2003 compared to the 1980s. True, the repealed federal law did include a drug benefit. But, that law was mandatory, quite unlike today's proposals for voluntary participation of Medicare beneficiaries. Moreover, Medicare premiums are not scaled to income under the proposed legislation, and unlike the past, today's legislation does not cover only very high expenses. Today, there is much less retiree health coverage from employers. And, prescription drugs are far more important in people's lives today, yet cost more. Another difference is that much has also been learned since the 1980s from the private sector and from the states on which to base today's proposed federal program.
Older Americans have now had to wait fourteen years for Congress to address this need again. We hope lawmakers can learn from the lessons of that decade. AARP believes a voluntary and affordable prescription drug benefit in Medicare that works for both middle class and lower income older Americans, while not threatening existing retiree health coverage, will go a long way to making life better in the United States today. Recognizing what history has to teach us can help us to design a program that works and that will retain the support of the American people. Rarely are there second chances in such major legislative efforts. America surely cannot afford to see the past repeated.
written by Woody Goulart for John Rother, AARP Director of Policy and Strategy