Secondly, expansion of Medicare has been hampered by divided government, recurring federal deficits and ideological conflict. Dr. Oliver said, "The main philosophic difference was between the 'marketists' who wanted more involvement of private industry in Medicare and the 'medicalists' who wanted to expand the traditional government program and preserve the autonomy of patients and medical professionals.
The pressure to add prescription drug benefits grew in recent years because of the short-lived federal budget surplus, a dramatic increase in drug costs and the perception of Republican Party leaders that they needed to demonstrate progress on an important issue for elderly voters if they wanted to maintain control of the White House and the Congress."
Thirdly, the current Medicare prescription drug benefit directly reflects previous proposals and mistakes of the past. In 1989, Congress repealed a limited Medicare drug benefit it enacted the previous year after seniors revolted against mandatory participation and seniors-only financing.
The new program that begins in 2006 will be voluntary, allowing seniors to opt out if they would prefer to keep coverage they currently have; and the program will be paid for not only by beneficiaries' premiums, deductibles and co-payments, but also by heavy subsidies from general revenues.
Dr. Oliver said, "Even so, we found that many of the same economic and political constraints that blocked the introduction of prescription drug coverage in the past are reflected in the current benefit, which appears to provide inadequate assistance for many beneficiaries."
Despite a price tag for taxpayers ranging from $409 to $550 billion over 10 years, beneficiaries will still have to pay $4,020 for the first $5,100 in annual drug expenses.
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Contact: Tim Parsons
paffairs@jhsph.edu
410-955-6878
Johns Hopkins University Bloomberg School of Public Health
23-Jun-2004