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Put Medicare prescription drugs on hold

By Richard E. Ralston
web posted November 7, 2005

Congress should put implementation of the new Medicare prescription drug program scheduled to begin in 2006 on indefinite hold. There are many good reasons to do this. The first is that the bill was based on false, if not ridiculous, financial assumptions.

Congress was told by the Bush Administration, and pretended to believe that the program would cost $400 billions dollars over the first ten years, but probably much more thereafter. At the time, there was no explanation of how the government would pay for that much spending. Now we are informed that the cost of implementation during the first ten years will be triple the original estimate--$1.2 trillion-before it starts to get really expensive later. That is a far bigger jolt to the Federal budget than the cost of recent hurricanes. It would pay for a handful of wars like Iraq. It is a financial disaster, and we need to stop the bleeding before it starts.

Some say they would pay for it by rolling back tax cuts on the "wealthy." That alone would not pay for it. Others say they would pay for it by rolling back all of the Bush tax cuts. They do not explain how those that cannot afford prescription drugs to preserve their own health can afford higher taxes instead. Unfortunately any tax increases are already committed many times over to other programs. Most of those who propose more taxes advocated a far more generous prescription drug benefit in the original bill. $1.2 trillion would not have been enough. They also want them to pay for hurricane recovery efforts. They have to pay for the wars in Iraq and Afghanistan. Huge shortfalls in Medicaid, Medicare and Social Security are also supposedly to be met by rolling back the tax cuts, as are the large increases in subsidies by the Agriculture Department. Others want to use these taxes to further increase the huge Bush increase in spending on Education. Ad infinitum. Tax increases would just be a tidbit swallowed up in the maw of the Leviathan.

The prescription drug program should be suspended until Congress designates specific spending cuts to finance it. Anything else is a flight from reality with ruinous consequences for our economy and our health. Even if Congress can find offsetting cuts for this monstrosity, a better case could be made that it is just not worth it.

What are retirees then to do? At least they will be spared the "surprise" of rising premiums, rising deductibles, larger "holes" in the middle, and restrictive formularies as the cost of the program goes into orbit. Only the Federal government can so effortlessly combine escalating costs and decreasing benefits.

It certainly can be a struggle to pay for prescription drugs in the last years of life, including the new expensive drugs that provide optimum benefits. Millions of retirees will still be covered by their former employers' retirement plans or their own private Medicare supplement policies-in many cases superior to the new government program. Those least able have access to Medicaid-as the rapid increases in spending for that program testify.

Other options for retirees should immediately be opened up that would cost a tiny fraction of the new program in forgone revenue. Those who have already been researching prescription drug policies for the new program should be allowed to purchase similar polices free of tax, or by freeing up for that purpose Health Savings Accounts-the use of which is now highly restricted for those on Medicare. Retirees, taxpayers, and pharmacists will also be spared the "cost of cost control" which the present bill entails, including the cost of 1300 pages of new Medicare regulations (added to the 130,000 already in print), paperwork, and the salaries of new administrators, regulators and enforcers

Perhaps one side benefit of delaying this confusing mess of a prescription program would be to provide funds for hurricane recovery. The Federal government could easily blow through these savings on other new spending. But at least while recovering from natural catastrophes we would not be starting down the road to another disaster.

Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine. Comments to mail@afcm.org.

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