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Bush, Democrats outline ideas for prescription drug benefit

Changes to Medicare eyed

By Sean Loughlin
CNN Washington Bureau

President Bush pauses during a speech he delivered to the American Medical Association.
President Bush pauses during a speech he delivered to the American Medical Association.

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U.S. President George W. Bush outlined his ideas for changing Medicare by offering seniors more choices on health coverage. CNN's Suzanne Malveaux reports (March 5)
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WASHINGTON (CNN) -- Wading into a politically sensitive subject, President Bush outlined his ideas Tuesday for changing Medicare by offering U.S. seniors more choices on health coverage, while House Democrats rallied behind a rival measure. Both sides said America's elderly would benefit from a new prescription drug benefit.

Bush said older Americans should have competing health-care plans from which to choose. Options would include sticking with Medicare -- a 38-year-old government program providing health coverage for about 40 million Americans -- or joining private-style health-care plans that would offer more generous prescription drug benefits.

"Compared to people with private health plans, Medicare patients have limited choices," the president told a conference of the American Medical Association in Washington.

But Democrats said Bush was laying the groundwork for privatizing Medicare and said seniors who stayed with Medicare wouldn't see much of a prescription drug benefit.

"President Bush may have revised the packaging, but the details are the same: You can choose your own doctor or you can get help with the routine costs of medication, but you can't have both," House Minority Leader Nancy Pelosi said Tuesday at a Capitol Hill news conference.

Tackling Medicare is a political sensitive subject for both the White House and lawmakers because it affects senior citizens -- a powerful voting bloc.

The president, in fact, did not unveil a specific bill, leaving that to Congress. Republicans had warned the White House that to commit to specifics at this stage was too politically risky.

In his speech, delivered to an enthusiastic crowd of medical professionals, Bush also repeated his call for limits on malpractice lawsuits, saying such litigation was compromising health care.

"We have a problem in America: There are too many frivolous lawsuits against good doctors, and the patients are paying the price," Bush declared, calling for a cap of $250,000 on lawsuits for noneconomic damages, commonly known as pain-and-suffering damages.

The notion of limiting malpractice awards was the subject of a hearing on Capitol Hill, and many Democrats said any such cap would be unfair to victims.(Full story)

There are political undercurrents to that debate that will likely play out on the campaign trail in the 2004 race for the White House. Trial lawyers, who largely support Democratic candidates, oppose limits on lawsuits, while the medical community favors them.

Reps. Mike Ross, left, Pete Stark and Nancy Pelosi talk at a news conference Tuesday on prescription drugs.
Reps. Mike Ross, left, Pete Stark and Nancy Pelosi talk at a news conference Tuesday on prescription drugs.

On the issue of revamping Medicare, the rhetoric is familiar. Bush cast the debate as a matter of forcing seniors to stick with "government-run health care" over more efficient private "innovation," while Democrats portrayed Republicans as opponents of Medicare who want to dismantle it.

Democrats want to fold a prescription drug benefit into the existing Medicare system. Under their plan, seniors would pay a premium of $25 a month and face an annual $100 deducible. There would be a $2,000 out-of-pocket limit for beneficiaries, and Medicare would pay 80 percent of drug costs.

The Democratic plan would cost an estimated $700 billion to $900 billion, more expensive than the $400 billion Bush has vowed to commit to overhauling Medicare.

"Our plan maintains the choices that matter most to the elderly and the disabled -- which doctor to go to and what pharmacy to use," Pelosi said.

The president stressed that seniors could remain with the current Medicare system. He called on Congress to provide America's elderly with a prescription drug discount card that would provide savings of 10 to 25 percent.

There would be additional coverage for those who have significant out-of-pocket expenses for prescription drugs, Bush said. A congressional source briefed on the plan said the threshold for this additional coverage likely would be about $4,000; once out-of-pocket expenses passed the threshold, the government would pay for additional drug costs.

Those who choose to receive care either through a fee-for-service arrangement or a managed care system would have a drug benefit integrated into the plan, as do most PPO (preferred provider organization) and HMO (health maintenance organization) plans offered by employers. The administration said it would leave the details of such plans up to Congress.

A third option would be what the White House dubbed "Medicare advantage," envisioned as a mix of managed care plans.

"All seniors should be able to choose the health care plan that best fits their needs, without being forced into an HMO," Bush said.

A White House blueprint released Monday said any Medicare plan should provide full coverage of preventive screenings for diseases such as cancer, diabetes and osteoporosis.

Bush failed to reach agreement with Congress last year, so he made Medicare a centerpiece in his State of the Union address in January. At that time, the White House said Bush would propose legislation of his own because he viewed the major congressional proposals, of which there are several, as lacking in one way or another.

Congressional Republicans complained on several grounds, however.

Some worried the White House would be asking Republicans to cast politically damaging votes on a proposal that had little chance of passage because of Democratic opposition. Others also said the White House should not disregard the significant bipartisan progress made on Capitol Hill in recent years, even if it had some substantive disagreements with those plans.

Senate Majority Leader Bill Frist of Tennessee, for example, has worked with Democratic Sen. John Breaux of Louisiana on a plan that has considerable support in the Senate.

CNN Senior White House Correspondent John King contributed to this report.

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