Poison Pill

To continue the series of topics not directly related to workplace safety: Medicare and Prescription Drug Bill. Because even if workers live to retirement, it's looking increasingly likely, if the Republicans get their way, that they won't have adequate health insurance to get through old age.

To listen to President Bush, the failure of Congress to pass a prescription drug bill is all due to (Democrat induced) partisianship.

"The choice is simple: Either we will have more debate, more delay and more deadlock, or we'll make real progress," Bush said in an appearance at Walt Disney World here. Urging lawmakers to break the stalemate, he added: "We've come far. Let's finish the job."

Well, at least he picked an appropriate place to make this statement.

The reality, however, is much, much different, but it's a reality shrouded in technical issues that almost no American will have the patience to decipher, even if they have the ability to find the information in the first place.

That's why NY Times columnist Paul Krugman is a national treasure. His ability to reduce complicated issues to terms that are short enough and clear enough for most people to understand is a talent that few politicians or journalists possess.

A Congressional conference is now trying to agree on prescription drug legislation. But beware of politicians bearing gifts — the bill will contain measures that have nothing to do with prescription drugs, and a lot to do with hostility to Medicare as we know it. Indeed, it may turn out to be a Trojan horse that finally allows conservative ideologues, who have unsuccessfully laid siege to Medicare since the days of Barry Goldwater, to breach its political defenses.
***

Meanwhile, another proposal — to force Medicare to compete with private insurers — seems intended to undermine the whole system.

This proposal goes under the name of "premium support." Medicare would no longer cover whatever medical costs an individual faced; instead, retirees would receive a lump sum to buy private insurance. (Those who opted to remain with the traditional system would have to pay extra premiums.) The ostensible rationale for this change is the claim that private insurers can provide better, cheaper medical care.

But many studies predict that private insurers would cherry-pick the best (healthiest) prospects, leaving traditional Medicare with retirees who are likely to have high medical costs. These higher costs would then be reflected in the extra payments required to stay in traditional fee-for-service coverage. The effect would be to put health care out of reach for many older Americans. As a 2002 study by the Kaiser Family Foundation judiciously put it, "Difficulties in adjusting for beneficiary health status . . . could make the traditional Medicare FFS program unaffordable to a large portion of beneficiaries."

What's going on? Why, bait and switch, of course. Few politicians want to be seen opposing a bill that finally provides retirees with prescription drug coverage. That makes a prescription drug bill a perfect vehicle for smuggling in provisions that sound as if they have something to do with improving Medicare, yet are actually designed to undermine it.

OK. Now I understand what's going on and what's at stake. The problem is how we get that message to everyone else who doesn't read the op-ed page of the NY Times every day?