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http://www.nytimes.com/2002/06/19/politics/19DRUG.html

A Health Care War Is Raging in the House

By ROBIN TONER

ASHINGTON, June 18 — The great health care war of 2002 has erupted with a vengeance, as Republicans began to push their prescription drug bill through the House this week. The ferocity has as much to do with the stakes in November's elections as with disputes over policy.

Democrats, and many of their allies among labor, retiree and consumer groups, are intent on portraying the Republican bill as a cynical exercise in political self-protection that seeks to neutralize an issue that traditionally helps Democrats with an important voting bloc — older Americans.

Critics say the Republican measure is a "sham bill," as Representative Richard A. Gephardt, Democrat of Missouri, put it today, that would not work because of its excessive concern with protecting the profits of the pharmaceutical industry.

Republicans counter that the Democrats are more interested in a campaign issue than an actual law.

As two House committees began to act on the Republican bill today, several Republicans deplored the "demagoguery" of the Democrats and asserted that they simply wanted to create a drug benefit for the nation's 40 million Medicare beneficiaries.

"I don't feel the issue should be the November election," said Representative Michael Bilirakis, Republican of Florida. Democrats shot back that the act of writing this bill was hardly bipartisan.

The deeply political atmosphere was underscored when the House Ways and Means Committee session was disrupted by protesters from the Alliance for Retired Americans, a union retiree group. They shouted, "Time to stop the doughnut!" and, "Time to make the doughnuts!" an allusion to the coverage gap — known to health policy aficionados as a hole in the doughnut — in the Republican bill.

Although many advocates and lawmakers are loathe to talk about it publicly, one of the few areas of consensus is that the chances of legislation's reaching final passage this year in such a polarized environment are very slim.

But the political implications of the debate are far-reaching — not just for a closely divided House, where a candidate's commitment to older Americans can be decisive in a midterm election, but also for the Senate. Republican strategists would like nothing better than to run against a Democratic-led Senate that it could describe as do-nothing and obstructionist if it failed to act on the Republican House bill, which is expected to pass next week, or to produce a drug benefit of its own.

As one Democratic strategist put it, "They'll run against us as obstructionist, and we'll run against them as tools of the pharmaceutical industry." Republican strategists argue that, for their candidates, passing a bill in the House takes the issue off the table.

Whatever the prospects for final passage, advocacy and industry groups cannot afford to let a bill they consider hostile to their interests advance unchallenged.

A drug benefit would be an expensive change in the 37-year-old Medicare program. Two-thirds of the elderly have some coverage for outpatient prescription drugs from other sources, but it is often limited and unreliable, while the rest have no coverage to cope with the soaring costs.

The House Republican bill would take a private market approach to the problem, subsidizing insurance companies to offer drug coverage to Medicare beneficiaries. While such "drug only" insurance does not now exist, Republicans say that the right subsidies will create it. Their plan would cost $350 billion over 10 years, far less than the main Democratic proposals. Democrats support adding a standardized drug benefit to the traditional Medicare program, available on a voluntary basis.

Given the stakes, groups on both sides are furiously weighing in on Web sites, newspapers, radio and television. One of the most high-profile, so far, is the United Seniors Association, a conservative group that is running a six-week $4.6 million television campaign on behalf of the Republican effort — and the Bush administration's general commitment to the elderly — in 18 Congressional districts.

"America's seniors," the advertisement declares. "They have been there for us. We need to be there for them." It urges voters to tell their congressmen to "work with President Bush" to pass legislation "to add prescription drug coverage to Medicare."

United Seniors officials acknowledge that they received an "educational" grant from the Pharmaceutical Research and Manufacturers of America, the industry group known as PhRMA. Democrats promote that fact as evidence that Republicans and conservatives are in an unholy alliance with the drug industry.

Charles Jarvis, chairman and chief executive of United Seniors, countered that his group, "a free market compassionate conservative group," is simply interested in passing a drug benefit.

PhRMA itself is running a newspaper advertising campaign declaring that "now is the time" to add drug benefits for the nation's elderly. One health care lobbyist noted that the group was pursuing an "inside/outside" game — talking to the public about its commitment to a benefit, while focusing its inside game on how that benefit would work.

The industry is bitterly opposed to price controls or other restraints on profits, which it fears would be an inevitable outgrowth of adding a drug benefit to the traditional Medicare program. It supports a more "market oriented" approach like that advanced by the Republicans, but a PhRMA spokesman said they have yet to endorse any bill.

On the other side, an alliance of consumer and retiree groups stepped up their opposition to the House Republican plan today.

Barbara B. Kennelly, president of the National Committee to Preserve Social Security and Medicare, said the House Republican plan "isn't workable." Ms. Kennelly, a former Democratic congresswoman from Connecticut, said her group would alert members to the shortcomings of the House Republican plan.

Liberal consumer advocacy groups say they are determined to highlight the differences between the Republican and Democratic plans.

"We believe the Republican strategy all along has been to introduce a bill, vote on it, and irrespective of the bill, to then be able to say, `We care.' " said Ron Pollack, executive director of Families USA. "Their assumption, which was accurate in 2000, is that if you say you have a bill, nobody can really understand the difference."

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