In a letter to President Clinton Sept. 25, Senate Majority Leader Trent Lott (R-Miss.) and House Speaker Dennis Hastert (R-Ill.) said their disagreement with the administration's and congressional Democrats' efforts to provide a Medicare prescription drug benefit for all seniors "will lead to inaction this year." Congress is expected to adjourn in early October.

"I am extremely disappointed by your determination that it is impossible to pass a voluntary Medicare prescription-drug benefit this year. I simply disagree," Clinton replied in a letter to the Republican leaders. "There is indeed time to act, and I urge you to use the final weeks of this Congress to get this important work done. It is the only way we can ensure rapid, substantial and much-needed relief from prescription drug costs for all seniors and people with disabilities, including low-income beneficiaries."

Like Republican presidential candidate George W. Bush, congressional Republican leaders back a scheme that would allow insurance companies, not Medicare, to design prescription drug policies—including setting terms for benefits, premiums and co-payments. In addition, the plan excludes millions of seniors from coverage. In a near party-line vote, the House passed such a bill June 28.

Less Coverage,More Costs Under Bush Prescription Drug Plan Comparison of Gore and Bush Medicare Outpatient Prescription Drug Proposals, 2002 and 2008. Source Kenneth Thorpe, Emory University (analysis reflects authors only, not Emory University.)

The drug industry-friendly provisions should not be a surprise. A recent report by Public Citizen's Congress Watch reports the drug industry has spent more than $230 million since 1997 to lobby Congress. More than 80 percent of the industry's donations to political parties have gone to Republicans.

In fact, the Federal Election Commission reported that during just a 13-day period in August, three major pharmaceutical companies gave $600,000 to the Republican National Committee. The three $200,000 donations came from Eli Lilly & Co., Bristol-Myers Squibb Co. and Pharmacia & Upjohn Co.

Meanwhile, on the presidential campaign trail, Vice President Al Gore focused on his Medicare prescription drug plan with a group of Iowa seniors Sept. 27. "Under my prescription drug plan, if you chose to participate, you can go to your own local pharmacy and get all the medicine your doctor prescribes for you. You get to see your doctor, and your doctor is the one who decides what medicine is right for you. Nobody has to go to an HMO, and no big drug company can veto that choice or take it away," Gore said.

The contrasts between Gore's call to establish a guaranteed prescription drug benefit for all seniors under Medicare and Bush's insurance industry-based proposal are stark.

In 2002, the first year of Bush's plan, just over half a million of the 15.2 million Medicare beneficiaries who do not have prescription drug coverage would be covered. To cover very low income seniors through 2004, the Bush plan relies on state programs that do not exist in most places. Through 2004, most middle-income seniors will not be covered. After that, Bush wants private insurance companies to offer prescription drug plans; his plan would require most beneficiaries to pay 75 percent of the premium cost up to $6,000. Once a beneficiary has spent $6,000 on needed drugs, 100 percent catastrophic coverage would kick in.

Gore's proposal covers almost all Medicare beneficiaries who do not have coverage in 2002, and most would pay premiums of just $25 a month. His plan would pay for all prescription drugs after a person spent $4,000 a year.

In addition, Bush's plan does not guarantee equal access to standard benefit packages. Medicare recipients with the same income and medication needs could end up with very different benefits depending on where they live and what private insurance plan is available in their communities. Gore's plan offers the same benefits to all beneficiaries, no matter where they live.