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Medicare Drug Benefits to Star In Congress’ Debate This Week

By Robert Pear

The New York Times -- WASHINGTON

As Congress begins a wrenching, politically polarizing debate over prescription drug benefits for the elderly this week, a central issue is whether private health plans can deliver better care, at lower cost, than the traditional Medicare program created 38 years ago.

Much of the debate will focus on the merits of private plans: Will they be acceptable to Medicare beneficiaries? Will they work? Will they save money? Will they improve the quality of care?

If Congress wanted just to add drug benefits to Medicare, it could do so by adding a few words to Section 1832 of the Social Security Act, which defines the “scope of benefits.”

But Congress is beginning a much more fundamental debate about the future of Medicare and the role of government, an issue that defines the philosophical differences between the Republicans and the Democrats.

President Bush, most Republicans in Congress and some Democrats are determined that Medicare must not pay for prescription drugs the way it pays doctors, hospitals and other health care providers: with a rigid, complex statutory formula that often bears little relation to the realities of local health care markets.

Bush plans to speak to doctors in Illinois on Wednesday and visit a senior center in Connecticut on Thursday, just as the Senate Finance Committee is scheduled to vote on legislation adding drug benefits to Medicare. The full Senate and House are expected to vote on the legislation later this month.

Republicans maintain, in the words of Newt Gingrich, the former speaker of the House, that Medicare is obsolete and antiquated because it does not cover drugs and because it relies on “a command-and-control structure to control costs.”

Testifying last week before a Senate committee, Gingrich said, “We are at the dawn of an explosion of knowledge that will change everything we know about science and the human body.” Breakthroughs in biology and technology in the next 20 years, he said, will equal all those of the 20th century. The best way to exploit the discoveries, Gingrich said, is to transform Medicare from a government monopoly into a marketplace of competing insurance plans, so the elderly will have more options.

“Choice creates competition, and competition drives down price,” Gingrich said, in a pithy statement of the philosophy that drives most of the Republican proposals.

Sen. Bill Frist, R-Tenn., the majority leader, said the goal was to revamp Medicare so “seniors can choose the type of coverage that best meets their individual needs.”

Liberal Democrats say Republicans are trying to privatize the program. “This is an effort by those who never supported Medicare in the first place to unravel the one piece of universal health insurance we have in this country,” said Sen. Debbie Stabenow, D-Mich.