The Placebo Effect

An exasperated man was laying out some dire math last week at a senior center in Rock Hill, S.C., as a morning crowd of silver heads nodded in empathy. The miracle drugs that keep his 94-year-old mother healthy, the man said, can cost $700 a month — far more than she can afford on her $42 pension check and $1,200 from Social Security. Those tiny bottles of glaucoma drops alone cost $95 every two weeks. She couldn't pay for them without the $400 he and his brother chip in every month. "If we were passing Medicare today," the man added, "we would never pass it without (including a benefit for) prescription drugs."

He ought to know. The man was House minority leader Dick Gephardt. But what Gephardt didn't explain was why Congress — for the seventh year in a row — has failed to do anything about this crisis. At a time of surging federal deficits, one reason is the price — $800 billion or more over 10 years to provide something close to coverage for all seniors. Conservatives don't want the largest expansion of entitlements since the launch of Medicare to happen on their watch.

But after last week's legislative debacle — which saw the death of a Senate bill that would have given a drug benefit to the neediest seniors — the prescription politics that have so favored Democrats in the past are suddenly getting slippery for them. The Republican- controlled House passed a drug proposal in June, but the Democratic Senate voted down four separate plans over the past two weeks. With the defeat of the final one, the legislative action is over until next year. Bring on the attack ads.

Democrats contend — and many health experts agree — that the House G.O.P. plan, which relies on private insurance companies to provide coverage, is unworkable. No such scheme exists on the private market, and insurers say that's because they simply can't offer it at an affordable price. To save money, the Republicans would cover a portion of drug costs up to $2,000 but beyond that would leave retirees on their own to pay for drugs until their costs hit $3,700.

That's the kind of fine print that could be lost on most people. Voters in 29 congressional districts — all but five of them Republican — have been hearing radio ads urging them to "thank" their local representative for voting "to add meaningful prescription-drug coverage to Medicare for all seniors." The ads were run by a conservative group called the United Seniors Association and financed by the pharmaceutical lobby — which helped write the House bill.

With half a dozen House Republicans vying this year for a promotion to the Senate, it's not surprising that Senate majority leader Tom Daschle felt a new urgency to pass just about any bill that might deny them bragging rights. The final compromise, proposed by Democrat Bob Graham of Florida and Republican Gordon Smith of Oregon, would have limited coverage to seniors of low and modest income and to those who face catastrophic costs. It was skimpier than legislation that Democrats had earlier rejected as inadequate. This time it got the votes of all but five Democrats. But with only four Republicans supporting the bill, it came up short.

Back in Daschle's home state of South Dakota, the Senate race has become a proxy war between the majority leader and President Bush. The prescription- drug issue "is going to play very badly" for Democratic incumbent Tim Johnson in his bid to defend his seat from House Republican John Thune, says Thune spokeswoman Christine Iverson. That may be why Daschle had Johnson give last Saturday's weekly Democratic radio address. Johnson used it to blame defeat of the Senate bill on the Republicans and contended the House plan "would do absolutely nothing to reduce the cost of prescriptions."

The talk has only just begun. This time, though, Republicans are likely to be making as much noise as Democrats. As the final proposal headed for defeat on the Senate floor last week, George W. Bush's Health and Human Services Department was granting a federal waiver so that three Governors can use Medicaid funds to expand drug coverage to poor seniors who don't otherwise qualify. One of the lucky Governors: Jeb Bush of Florida. Helping is what family's all about.