08-10-2002

POLITICS: Prescription for Punishment

Now that four prescription drug plans have failed in the U.S. Senate, the
question becomes: Who pays-not for the drugs, but for the broken
promise?


In the 2000 campaign, both parties made the same promise to seniors.
Here's Al Gore, August 28, 2000: "I will pass a prescription drug
benefit for seniors. Together, we'll make it happen." Here's George
W. Bush, September 11, 2000: "Prescription drugs for seniors are
going to be not only a priority, we're going to get something done."
What happens now?


We know three things about seniors. One, they vote. And they have an
especially large impact on midterm elections, when other people don't
vote. In the 2000 presidential election, voters age 60 and older made up
22 percent of the turnout. In the 1998 midterm, they accounted for 28
percent.


Two, seniors swing, at least politically. In the last six presidential
elections, seniors voted Republican three times (1980, 1984, and 1988) and
Democratic three times (1992, 1996, and 2000). A Democratic trend? Well,
no, because in three out of the last four House elections seniors
nationwide voted Republican.


The House vote among seniors was crucial in 1998. That was the impeachment
midterm, when Democrats upset all expectations by gaining House seats.
Seniors swam against the national tide, however, and favored Republican
House candidates by a 10-point margin (55 percent to 45 percent). It was
because of seniors that Republicans retained controlled of the House.
Seniors, more than any other constituency, were offended by President
Clinton's personal behavior.


In 2000, the senior vote for the House reversed and went Democratic, 51
percent to 47 percent. As a result, the House nearly reverted to
Democratic control. What propelled the senior vote that year? Concern
about prescription drugs and Social Security.


That leads to the third distinctive feature of senior politics. They care,
particularly about issues that affect them. The top two issues among all
voters right now, according to Gallup, are the economy and the war on
terrorism. Among seniors, the top two issues are still Social Security and
prescription drugs.


The senior vote is no longer reliably Democratic, as it used to be when it
was dominated by the Depression generation. New generations entering their
retirement years are not as instinctively Democratic. They continue to
vote Democratic when senior benefits, such as Social Security, Medicare,
and prescription drug coverage, are uppermost in their minds. But when the
"values agenda" dominates, as in 1994 and 1998, seniors favor
the GOP.


If angry seniors now feel betrayed on the prescription drug issue, whom
will they take it out on? "The House has acted," Senate Minority
Leader Trent Lott, R-Miss., pointed out on July 17. "The Senate needs
to produce a result." It didn't. After a Senate floor debate that
lasted more than two weeks, four plans each failed to get the 60 votes
needed to end debate and force a vote on its substance.


On prescription drug coverage, two basic issues are in contention. Should
all seniors be covered, or just those with low incomes or high drug costs?
And should the coverage be provided by the government or by private
insurers? First, Senate Democrats proposed covering all seniors through
Medicare, at a cost of nearly $600 billion over 10 years. That Democratic
plan got 52 votes on July 23. The same day, the Republicans' $370 billion
proposal, which would have subsidized coverage for all seniors through
private health care insurers, got 48 votes.


Each party then scaled back its proposal by targeting the benefits to
people with low incomes or high drug costs. The targeted Republican plan
(price tag: $160 billion) got 51 votes on July 24. The targeted Democratic
plan (price tag: $390 billion) got 49 votes the same week. Both parties
were willing to compromise on the scale of coverage. But neither party
would compromise on whether the prescription drug program should be part
of Medicare or rely on private insurers.


In the Democrats' weekly radio address last Saturday, Sen. Timothy P.
Johnson of South Dakota blasted the GOP approach, which he said would
"force seniors into private drug HMOs rather than create a guaranteed
benefit in Medicare." He charged, "The big drug companies joined
with the large insurance companies to defeat the Senate Democrats' plan,
and their Republican allies listened to them."


Democrats claim to have greater credibility on the issue. Polls back them
up. By 50 percent to 33 percent in last month's Gallup Poll, the public
said that Democrats would handle the issue of prescription drug coverage
better than Republicans. And Democratic voters care about the issue more
than Republican voters do. Forty-seven percent of Democrats, compared with
31 percent of Republicans, described prescription drugs as an
"extremely important" factor in their vote for Congress this
year. And angry Democrats are more likely to vote than defensive
Republicans.


One Democratic old-timer puts it this way: "In 1964, I was here in
the United States Senate when we had the great debate on Medicare, and in
that year, the debate was lost. About seven months later, with a new
Congress, we came back in 1965 and passed Medicare. The major intervening
event was an election."


That was Sen. Edward Kennedy, D-Mass., on July 11. His fellow seniors were
around then. They remember. That's what Democrats are counting on.


William Schneider

National Journal