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Politics : Politics for Pros- moderated -- Ignore unavailable to you. Want to Upgrade?


To: Lane3 who wrote (29834)2/16/2004 7:41:55 AM
From: John Carragher  Respond to of 793649
 
Medicare hypocrisy

By Robert Goldberg

What's wrong with the new Medicare bill? Nothing that a little honesty couldn't cure. A recent Wall Street Journal article suggests that the problem is not so much the substance but the failure of Republicans to rise up in defense of the measure. Since the day the bill was passed, Democrats, labor unions and seniors from retirement villages have been holding rallies and press conferences to scream about how the law is either "scamming" seniors or cheating them out of more generous private-sector coverage in order to pay off "Big Pharma and insurance companies."
They are also annoyed that the drug benefit only pays for half of all drug costs and begins two years from now — not immediately. They want the pharmacy benefit management companies in the law to be replaced by Medicare price controls and a national drug list. Some disgruntled Republicans aren't helping matters much by saying "I told you so" after learning that the Bush administration's estimate of adding a drug benefit to Medicare exceeded the Congressional Budget Office (CBO) number by more than 25 percent.
To paraphrase Mark Twain, let's get the facts straight and then distort them as we please. As an article in Health Affairs reports, the president "proposedanoutpatient prescription drug benefit to be offered under a new voluntary Part D of Medicare ... Medicare would pay half the cost of covered drugs ? The drug benefit would be administered by a [private] pharmacy benefit manager." To help seniors maintain more generous private-sector coverage, "the president's proposal had incentives for employers to keep [drug coverage]. Medicare would pay employers 67 percent of the premium subsidy costs it would have incurred if retirees had enrolled in Part D instead."
Sound familiar? This proposal was supported by virtually every Democrat. But it wasn't President Bush's plan; it was Bill Clinton's. And it had three big differences. First, it was scheduled to kick in four years after it was to pass in 1999, not in two as the Bush plan anticipates. Second, it covered a lot fewer people. And third, the Clinton plan didn't cover catastrophic drug spending; it capped government spending at about $2,500 per senior with some adjustment for inflation. The Bush plan covers all drug costs over $3,000 a year.
They are similar in one important respect: the estimated costs of both plans were revised upwards by about 25 percent for the same reasons. The Health Affairs article on the Clinton plan, which was written by CBO analysts, noted that theCBO"estimateof Medicare costs for the drug proposal was about 24 percent higher than the Clinton administration estimate." The main reason for this difference is that the CBO "assumed a higher annual rate of growth for drug costs in the future."
Contributing factors included increased utilization because "new low income subsidies would eliminate out of pocket costs" and because the new drug plan would "offer a more generous drug benefit package than standard Medigap plans now do, and at a lower premium." Finally, "people [who] received Medicaid benefits under the proposal also would enroll in Part D because states, which are responsible for their drug costs, would sign them up for Part D to reduce their Medicaid expenditures."
Not surprisingly, these are the very same reasons that the Bush administration had for coming up with an estimate that was about 25 percent higher than the CBO estimate of $400 billion for the Bush drug plan. The Medicare actuaries used almost the exact same language as the CBO analysts in coming up with their estimate. They noted that estimates are highly uncertain because "the effects of the new benefit on the behavior of beneficiaries, physicians and employers are difficult to predict ... projecting future drug spending is highly speculative even without newcoveragebecause spending depends partly on the rate and direction of technical change which cannot be accurately foreseen."
It took 30 seconds to track down the Health Affairs article. It would take even less time to hunt down the speechifying of Sens. Ted Kennedy, Tom Daschle and John Kerry praising the Clinton plan, which is the Bush bill, albeit with less money for seniors, less choice and a longer waiting period before receiving benefits. Today, Democrats seek to repeal a measure that is exactly like the one they supported less than four years ago. Why haven't Republicans made more of this hypocrisy, and why hasn't the media asked Democrats to explain why the 25 percent difference in estimated drug spending wasn't a giveaway to private companies in 1999 but is now?

Robert Goldberg is director of the Manhattan Institute's Center for Medical Progress.



To: Lane3 who wrote (29834)2/16/2004 8:05:35 AM
From: LindyBill  Read Replies (1) | Respond to of 793649
 
I'm afraid I just can't find a way to be happy for you.

You sure are getting picky lately. :>) Politics has always been a blood sport. The issues just fill the banners and give the naive something to talk about.



To: Lane3 who wrote (29834)2/16/2004 8:06:37 AM
From: Lane3  Respond to of 793649
 
Winning the Post-Postwar

By Jackson Diehl
Monday, February 16, 2004; Page A27

Even as it tries to orchestrate a handoff to a sovereign government in Iraq, the Bush administration has a chance to avoid repeating a critical error it made a year ago. Then, focused on the imminent military campaign, the administration failed to prepare a workable plan for the postwar occupation. Now, despite its priority of installing an Iraqi government by July 1, it needs to come up with a clear strategy for how to handle the post-postwar Iraq -- a country that will be far from stable but no longer under U.S. administration.



Senior administration officials know, at least, what they most want to avoid: the eruption of a civil war among Sunnis, Shiites and Kurds, or an attempt by clerics to establish an authoritarian Islamic state. Maybe a few still count on a winning scenario -- a smooth segue to a pluralistic Iraqi administration, a waning of the resistance, a steady easing of the burden on the American military as NATO and Iraqi forces step in.

Either outcome is possible. But more likely is a muddle, a mix of nation building, violence, economic recovery and chaos, with U.S. troops and a huge new U.S. Embassy playing the role of referee and adviser as well as political scapegoat and terrorist target. Even in the best case, the sorting out of these countervailing forces and the emergence of a new Iraq will take years. Which raises a few questions: How will we know when we've succeeded? When will it be safe to scale back or withdraw? And, assuming the parameters of success can be defined, what practical strategies will help achieve them?

If the administration is thinking hard about these questions, there isn't much sign of it -- any more than there appeared to be good plans last February for the immediate postwar. As then, however, lots of people outside the government are working on the post-postwar problem, hoping to have some influence on what too often has been a hermetic policymaking process.

One group with ideas is the Post-Conflict Reconstruction Project of the Center for Strategic and International Studies, headed by Frederick Barton and Bathsheba Crocker, two veterans of the State Department, United Nations and National Security Council. Their aim has been to draw up a list of specific conditions that would be present in a successful Iraq, each of which could serve as a barometer of progress.

"It's not a nation-building model," says Barton. "One of the weaknesses in Iraq is that the coalition effort has been bureaucratized to bring order out of chaos, which is probably more admirable than achievable. What you are really trying to do is steer chaos in the right direction." Success should be measured not by whether ideal political conditions are created, he says, but by whether there is movement toward "a tipping point where you can start to hold people responsible."

Rather than focusing on institutions, the parameters describe the experience of Iraqi citizens. Barton and Crocker have written eight statements that "an average Iraqi must be in a position to make in order for reconstruction to succeed." The first, predictably, is: "I can travel around my city or town without fear of attack." The next, "I have a means of income." Those that follow cover expectations that crimes will be prosecuted, that religious and ethnic groups will not be persecuted, that children will be able to go to school, that hospitals and clinics will provide health care, that there will be religious freedom. And: "I have some say in who governs me and how they do so."

Crocker points out that the U.S. occupation administration tends to quantify progress by how many attacks are launched daily against U.S. troops, how many Iraqi security forces have been trained or how many megawatts of electricity are produced. Although they have some meaning, such statistics don't really show whether life for Iraqis is getting better or whether the political situation is moving in the right direction. If the focus remains on them, the administration could end up using its aid money and diminishing political leverage for the wrong ends.

Crocker and Barton say concentration on their list would lead to some smaller-scale and decentralized tactics. Rather than try to repair the entire Iraqi electricity grid by summer, it might be better to import more small generators to areas where blackouts are chronic. More attention might be paid to setting up accountable and representative local governments in cities and towns, while lowering expectations for what the first national government might accomplish.

Most important is encouraging civic participation by as many Iraqis as possible so that over time, a genuine civil society and democratic political movements can grow from the ground up. That, of course, will take patience and staying power. The danger is that, in the absence of clear goals or measures of success, pressure will grow in Washington to declare an arbitrary victory and withdraw. "Don't give these new leaders too much to do too soon," advises Barton. The corollary is: Be prepared to stay until they are able to deliver.

© 2004 The Washington Post Company