Contrast between House, Senate seen in debates over Medicare

WASHINGTON -- Debate over improving Medicare began with a tone of bipartisanship in the Senate, but the mood was decidedly less cooperative in the House.

Not all Senate Democrats were satisfied with the legislation moving toward near certain passage, but many were supporting it nonetheless.

"This may not even be half a loaf, but it is a start," Senate Minority Leader Tom Daschle, D-S.D., said Tuesday, as the Senate opened its second day of a two-week debate. The bill creates a structure that Congress can improve over time, he said. "It gives us a chance to build."

House Democrats were less optimistic, releasing an analysis by Consumers Union that found Republican bills in both the House and Senate lacking.

The group calculated that the proposed drug benefit was so meager that in just a few years, given inflation, seniors would be spending more than they do today on prescription drugs.

"Medicare beneficiaries have waited a long time for help, but unfortunately, this legislation falls far short of what seniors and disabled Americans have been waiting for," said House Minority Leader Nancy Pelosi, D-Calif., who planned a news conference Tuesday to take apart the GOP bill.

The bill was being considered by two House committees starting Tuesday, with a floor vote expected by July 4.

Claiming credit

In the Senate, there were few harsh words. Rather, both parties claimed credit for the legislation, which represents the largest expansion of Medicare since its creation nearly four decades ago.

Sen. Mitch McConnell, R-Ky., the GOP whip, opened debate Monday by crediting President Bush with making victory a realistic possibility after years of political promises.

But Sen. Edward M. Kennedy, D-Mass., said Democrats and senior citizens had forced Republicans to back off a Bush plan that would have required seniors to join managed care plans if they wanted full drug benefits.

Unlike his Democratic colleagues in the House, Kennedy said the bill offered enough help for seniors to win his support.

The measure would subsidize prescription drug coverage while giving private insurance companies an unprecedented role in the government's giant health care program for the elderly and disabled.

Private insurance companies would offer drug coverage for seniors beginning in 2006. Daschle said the Democrats' first amendment would allow seniors to get drug benefits from the government directly, rather than through private companies.

Both the House and Senate bills also allow seniors to sign up for privately run preferred provider organizations, where patients are encouraged to use doctors and hospitals on the company's list but can go elsewhere for an extra charge.

Supporters said the changes would make the program stronger, by giving participants more choices. It's hoped that those choices will lead to competition among private firms and drive down costs.

"We want a strong Medicare program that meets the needs of our grandparents, our parents' and our children's generations," said Sen. Susan Collins, R-Maine.

House GOP develops bill

Unlike the bipartisan collaboration that has marked the Senate's work, in the House, Republicans drafted their bill alone. And the prospect was for a fierce partisan struggle there.

The House GOP bill goes further than the Senate to inject private companies into Medicare. Beginning in 2010, the traditional Medicare program that now serves some 90 percent of beneficiaries would have to compete with private companies for business, and if the government's costs were higher, it would cost seniors more to stay with the government plan.

Democrats say that, over time, more healthy Medicare recipients would gravitate toward cheaper private coverage, leaving traditional Medicare to provide coverage for an increasingly older, sicker population. That, they say, would lead to a large disparity in the premium price.

Still, House Democrats were complaining loudest about the size of the prescription drug benefit. Congress set aside $400 billion over 10 years for Medicare changes, enough to cover less than 25 cents out of every dollar spent on prescription drugs for seniors.

The Consumers Union report assumes that drug spending will continue to explode, rising 17 percent a year. That assumes that a variety of efforts to control drug spending will fail, including federal legislation to encourage generic drugs and state initiatives to control drug spending Medicaid programs that could have spillover effects to Medicare.

The report says the average Medicare beneficiary will use $2,318 in drugs this year, rising in the years ahead.

The government would be picking up a piece of the tab under both the House and Senate bills: $1,400 under the House plan, and $1,829 under the Senate plan.

But drug inflation will overwhelm the benefit in coming years, the report concludes.