Senior Capitol Hill staff members outlined prospects for passage of a Medicare prescription drug benefit this year during a Commonwealth Fund conference Wednesday on “Options and Possibilities.” Julie James of Health Policy Alternatives gave an excellent overview of drug coverage options, from competing private plans (Thomas, Breaux/Frist), to a drug benefit add-on for existing Medicare (Daschle, Graham), to drug cards (Bush, Galen Institute), and a “benefit swap” (Senate Finance 2000) to allow people to select a redefined comprehensive benefit package for Medicare that includes prescription drugs. John McManus, staff director of the House Ways and Means Subcommittee on Health, said the House leadership wants a vote on a drug benefit bill by the end of May to give the Senate time to pass a bill of its own. He outlined areas of agreement with Democrats, including making sure that the benefit provides assistance for all Medicare beneficiaries, with special subsidies for those with low incomes, and assuring that government will serve as a back-up so plans or other options are available in all areas of the country. Further, he said there was basic agreement on the cost of a benefit: $350 billion for the House and $400 billion for the Senate ($500 billion budgeted, minus $100 billion for the uninsured). Liz Fowler, chief counsel on health for Democrats on the Senate Finance Committee, agreed that, “Once you get to agreement on costs, it is easier to get a bill.” She also said that Democrats are comfortable with the concept of prescription drug management firms and the need for incentives for efficiency. But she said that the structure of the program would need to track current Medicare benefits, with a government-defined benefits package, low deductibles, and small co-payments on drugs. Fowler said that Senator Charles Grassley is leading a tri-partisan group of Senators to develop a Senate bill. Patrick Morrissey, deputy chief of staff of the House Energy and Commerce Committee, focused on the problems involved in new federal funding for state-based programs, as the Bush administration has recommended, “which make it more difficult to reform the program in the long run” and may drain resources from those who need help the most. Our perspective: Democrats and Republicans are too far apart to come to agreement on a drug benefit this year, there is too much political capital in play to take this off the table as an election issue, and seniors are simply not educated enough about the options for a benefit for Washington to be spending this kind of money. And if Congress acts without properly educating seniors about the options and trade-offs, they could be faced with another Catastrophic Coverage failure as in 1989. And finally, some good news from the West Coast: California Gov. Gray Davis and Republican challenger Bill Simon squared off this week in a debate before the California Medical Association. Davis defended the status quo. Simon called for “wholesale changes,” including “tax incentives that will empower individuals to seek the care that is right for them.” “We have the finest hospitals, physicians and nurses the world has ever known, but you’re mired in a system that doesn’t work. We need fundamental reform, and let that process begin with this campaign between Gray Davis and me.” Simon’s bold and visionary speech earns three cheers. You can read it at: www.simonforgovernor.com/showArticle.php?id=380 As California goes? Grace-Marie Turner