The great divide on prescription drugs


WHAT'S THE BEST way to help seniors pay for costly prescription drugs that help them lead longer, healthier lives?

Vice President Al Gore prefers a prescription drug option tacked onto Medicare. His Republican presidential opponent, Gov. George W. Bush, wants HMOs and other private insurers to offer subsidized drug benefits to people 65 and older.

The two men take starkly contrasting views. Mr. Gore envisions a government-run, defined-benefits program that offers predictability and certainty for seniors about drug costs. Mr. Bush seeks a non-government solution so seniors have broader health-benefit options and a variety of prescription drug alternatives.

Of the two approaches, Mr. Gore's is the more pragmatic. Mr. Bush relies on HMOs to make his prescription-drug program work. Yet these same companies have run up big losses in their health-care programs for seniors; most HMOs have gotten out of this business. So how can they now be trusted to run a drug program for seniors?

Mr. Bush's plan also fails to tell us what seniors would pay under private drug programs. HMOs would be able to set any co-payment and deductible levels they wish and change the rates -- as well as the benefits -- at will. Seniors, therefore, could face a bewildering number of health-care choices under the Bush initiative.

Both Mr. Bush and Mr. Gore want government to pick up catastrophic costs for seniors with extraordinary drug needs. Their two programs also would pay all drug costs for low-income seniors.

For the rest of America's vulnerable, aging population, Mr. Gore offers a Medicare add-on, vs. Mr. Bush's private-insurance approach. We like the Gore version for several reasons.

First, it holds a better chance of reducing prescription drug costs -- for seniors and for the government. The federal Health Care Financing Administration, in Woodlawn, would be in a stronger position to negotiate lower drug prices with pharmaceutical companies than would individual insurers.

Second, a prescription-drug program isn't what private insurance companies do best -- manage a risk. They'd just be managing a benefit whose costs could be difficult to control.

Third, a Medicare add-on would be easier to administer compared with a multiplicity of HMOs with different offerings.

Fourth, seniors want -- and deserve -- stability. Constantly changing benefits and charges from HMOs, and conflicting sales pitches from HMOs looking for new sign-ups, would confuse and mystify many seniors.

Fifth, seniors want a drug program that's simple to understand and to use. Showing your Medicare card at any drugstore is about as simple as you can get.

On average, seniors spend $600 to $800 a year on prescription medicine. Many spend thousands of dollars each year. And 13 million Medicare recipients -- most with low incomes -- have no drug coverage at all. No wonder this issue is now center stage in this year's presidential campaign.

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