Medicare Drug Plan Could Be Painful for Democrats
$400 Billion Proposal May Steal Issue From '04 Candidates, Creating Dilemma for Party Strategists
By Ceci Connolly
Washington Post Staff Writer
Saturday, June 21, 2003; Page A06
Be careful what you wish for, you might get it!
As Congress races to enact a $400 billion Medicare prescription drug plan, Democratic candidates, especially the nine running for the White House, must confront a painful new political reality -- they may lose the edge on one of their most potent campaign issues.
In the four decades since Congress created Medicare, Democrats have consistently reaped electoral gains as the champions of the popular health program for retirees. But with President Bush and the Republican-controlled Congress ready to approve the largest expansion of the program in history, Democrats have been largely shunted to the sidelines.
After nearly five years of failed attempts, "passage of a drug benefit this year will really take the Medicare drug issue out of the presidential election," said Robert Blendon, a Harvard University pollster who released the findings of his latest Medicare survey Thursday.
"The president is going to say this is historic, it's the most comprehensive bill ever," Blendon said. "It will be very hard for the Democratic candidates to move a lot of voters" simply by talking about Medicare.
The sudden and surprising prospect of passing a Medicare drug law has sparked sharp debate within the Democratic Party over whether to support a bill that many argue is insufficient, but that nevertheless could be a beneficial first step.
"Democrats are in a tricky position," said Doug Hattaway, a Boston-based Democratic consultant. "They are torn between trying to make a difference on an issue they care about and not losing the political benefit the issue has provided." While some, such as Sen. Edward M. Kennedy (Mass.), are urging colleagues to use the 10-year, $400 billion plan as a down payment on more comprehensive coverage, others, such as Sen. John D. Rockefeller IV (W.Va.), are lobbying against the legislation because it falls far short of meeting seniors' needs and could lead to privatization of Medicare.
For the presidential candidates, the dilemma is particularly acute, and the political calculus stretches far beyond Capitol Hill to primary states such as Iowa, New Hampshire and South Carolina.
Compromise, said Hattaway, may be a successful legislative strategy, but campaigns are won by drawing sharp contrasts. "Marginal differences in policy approaches and outcomes are not particularly effective messages" on the campaign trail, he said.
"It's problematic," said former Vermont governor Howard Dean, one of the few candidates to acknowledge the quandary. "Do you pass it to establish an entitlement for prescription drugs, or do you wait to do something meaningful?" Dean, like most of the other candidates, is waiting for a final version before taking a position.
Heading into this election cycle, Democrats hoped to score points by accusing Bush of neglecting domestic concerns, with Medicare as Exhibit A. For years, voters have clamored for a drug benefit, and Bush has the added pressure of having pledged in 2000 to deliver just that.
Though the bills zipping through Congress barely resemble the changes promoted by Bush, he is most likely to claim -- and receive -- credit for any legislative achievement, analysts predict.
Republican pollster Bill McInturff described the likely commercial: "For the first time in two generations, President Bush created a dramatic new benefit in Medicare. Soon you will get drug coverage."
Although Hattaway complained Bush is merely "paying lip service to Democratic priorities," such as Medicare drug coverage, he said the president has the political upper hand. "The bummer is, Bush is checking another box on the domestic agenda."
In polls and focus groups conducted for the Henry J. Kaiser Family Foundation, researchers spotted a surprising shift in attitudes, ranking Bush even with congressional Democrats on the issue of Medicare, said Kaiser Foundation President Drew E. Altman. "That is the result of several years of Republicans no longer ceding this issue to Democrats," he said. "There is a real burden for Democratic candidates to convince the American people there are problems with the Republican approach and they have a better alternative."
One way Democrats are trying to gain the high ground on health care is by emphasizing a commitment to expanding health insurance.
So far, Rep. Richard A. Gephardt (D-Mo.) is exerting the greatest effort to make that case. He characterized both the House and Senate versions as "dangerous steps toward privatizing Medicare" by using private firms to administer the drug packages. "We are better off not doing a bill than doing these bills," Gephardt has said.
Most of his primary opponents are adopting more fluid positions -- and generally steering clear of the debate on Capitol Hill. The major complaints with the two bills revolve around the prospect of relying on the private sector to deliver the drug coverage and the fact that $400 billion is about one-fourth what seniors are expected to spend on medication over the next 10 years.
"I can see how I would support it," said Sen. Joseph I. Lieberman (D-Conn.), adding that he remains undecided. "It's a step toward where we ought to end up, which is a prescription drug benefit for every senior."
Sen. Bob Graham (D-Fla.) describes the Senate bill as "marginally better than the status quo." He fears the benefits package will not be enough to attract large numbers of seniors, which would jeopardize the financial solvency of the overall program.
Several complained that the legislation would not take effect until 2006, or, as Lieberman joked, "halfway into my first term." Sen. John Edwards (D-N.C.) is almost skipping over the Medicare debate and leaping to a more far-reaching discussion of what ails the entire U.S. health system. "It's wrong for us not to do something to bring down the cost of prescription drugs, not just for seniors, but for all Americans," he said.
Despite credible criticisms of the Medicare legislation, Blendon and Hattaway said the Democrats challenging Bush need to run on other issues, such as the economy, where the party positions have not been blurred. "It makes sense for Democrats to fight as long and as hard as they can to get the best possible deal for seniors, but then they have to move on," Hattaway said. "The election is not going to turn on this issue."
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