With a doctor in charge of the Senate, compassionate conservatism is well positioned to run roughshod over the issue that traditionally worked well for Democrats--healthcare. The Republicans' parsimonious plan for a senior citizen prescription-drug benefit will be among the first issues taken up by the new Congress. The Bush Administration has signaled that it wants to link the benefit to turning Medicare over to the insurance companies--legislation that Senator Bill Frist, the new majority leader, knows all too well, since he sponsored it in previous sessions. It doesn't matter to the privatizers that Medicare + Choice plans, the government's pilot project on privatization, have been a disaster almost everywhere they've been tried. They cherry-picked the relatively healthy seniors while subjecting the frail elderly to canceled policies, higher co-payments and burdensome extra charges. Yet the Republicans are intent on using prescription drugs as a wedge for their long-term goal of privatizing the entire government-run program. Given the confusion they were able to spread about drugs during the recent campaign--fueled by the tens of millions of dollars the pharmaceutical industry poured into surreptitious advertising campaigns--they may well get their way, unless Democrats find their voice on the crucial drug issue.

Defenders of Medicare must be crystal clear about why the pharmaceutical manufacturers have been so intent on derailing the Democrats' senior citizen drug plan. You'd think the industry would prefer a plan that spends nearly $600 billion on drugs in the next eight years over one that spends about half that amount. Moreover, under the Democratic plan, more seniors would be taking more drugs, because its lower co-pays and more generous benefits would encourage them to fill their prescriptions or stop cutting their pills in half to make ends meet.

There is one reason for the industry's visceral opposition to the Democrats' plan: It is government-run. That means the Centers for Medicare and Medicaid Services (CMS, the agency formerly known as HCFA) would begin meddling in how the taxpayers' money gets spent, just as it currently sets the fees that hospitals and doctors receive from Medicare. (Little-known fact: Medicare costs have gone up much slower than other healthcare costs in recent years--and are well below private health insurance premiums.) CMS might one day establish lists of preferred drugs and use its purchasing power to negotiate lower prices for drugs on the list--a fate the drug industry wants to avoid at all costs.

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