10/06/00 11:45 a.m.
Gore's Choice Sham
Gore's plan protects the powerful at expense of the people.

By Robert Goldberg

eorge Bush should not wait until the next debate on domestic policy to pound Gore on his sorry prescription-drug record. If Gore's lies make his credibility as a candidate weak, then prescription drugs should be the Achilles heel of his campaign because nowhere are the lies and the hypocrisy laid on with more consistency. Thanks to Jonah Goldberg (no relation but Jonah can still come to my son's Bar Mitzvah if he wants) we now know Winifred Skinner doesn't have to collect cans to pay for her drugs. She could live rent-free on her son's estate and then some. We also know that Gore's mother isn't paying more for the same drug Gore is giving his dog. In fact there are no pet versions of drugs that are safe for people to take in any event and even if there were in most cases the generic human versions cost less than the brand pet versions.)

But there's more. Gore lied about the Bush drug plan, something he got away with because apparently Bush knew less about the proposal then he did. Gore has criticized a short-term Bush plan to provide seniors drug coverage through state drug plans because it "would only reach approximately 625,000 of the currently 13 million uninsured seniors nationwide — leaving 95 percent of currently uninsured seniors without coverage, according to one study." Wrong. More than 50 percent would be covered by the short-term plan. The rest, including man with high blood pressure who Gore flew in for the debate, spend less than two percent of their income on drugs and therefore do not elect to purchase coverage through Medigap, existing state programs or through remaining HMO Medicare plans. (By the way, if the Gore campaign cares so much about these people, why not take the money it spent on airfare and hotel costs and spend it on medications instead?

If we can't trust Al Gore to tell the truth about simple stories and the facts of his opponents plan, can we trust him to keep his word to seniors that they will get the medicines they need? Apparently not. Bush should hammer hard on the Clinton-Gore horror stories of drug restrictions. Al Gore has marched with cancer victims, boasting that he has invented the administration's cancer policy and pledged to wipe out cancer in his administration. But as Bush pointed out once and then has failed to note, his administration has gone after access to cancer drugs with a vengeance in ways that would have forced seniors to receive care in hospitals and with outdated medicines.

His talk of choice is a sham. When Gore says doctors will be free to have a choice, does he mean those in Medicaid and the Veterans Affairs who don't have access to all the best drugs for cancer, schizophrenia, depression, high cholesterol and Parkinson's? Gore promises that private companies, not government bureaucrats, will administer, his drug plan. But at a recent White House conference on drug costs, the private drug-benefit companies told the gathering that limiting access to new drugs is the one tool they would have to use to clamp down on spending under a Gore-style drug plan. However it also seems when consumers have a choice of health plans — that's the Bush plan — the pharmacy-benefit plans are less likely to clamp down when there's only one provider and no exit as in the Gore proposal.

The fact is, Gore's plan protects the powerful at expense of the people. Why? Drug spending would rise so fast because so many rich seniors who could otherwise afford their own drugs would now get subsidized premiums and half of their drug costs paid under the Gore plan. Rationing, generic substitution, limited reimbursement of new drugs will kick in. Who will the rationing and lockouts hurt the most? The poor seniors, the same poor seniors Gore sneeringly criticized observed the Bush plan for targeting at the expense of the nearly 40 percent of seniors with incomes of $33,000 a year and over and who spend less than one percent of their income on drugs. The same 40 percent that suck up most of the benefits under the Gore plan.

Such limits directly harm the health of seniors. A study by health researcher Susan Horn looked at seniors in six HMOs and found they were twice as likely to be harmed by limits on access to new drugs as people under the age of 65. Worse, the negative impact of restrictions on seniors was twice that of individuals under the age of 65. That is, faced with the same restrictions as someone 65 and under, an elderly person in the same HMO was twice as likely to be hospitalized or need to see a doctor as a result of the loss of choice. Horn also found that among the six HMOs, the seniors under plans that had the least restrictions and more continuity of care with specialists did better.

And here's where Bush should have asked Gore if it's fair if Winifred Skinner should be collecting cans to pay for the prescription-drug coverage of people like Bill Gates or his father, especially when the lives of so many less fortunate seniors are at stake? Why does Gore target tax cuts to the middle class but give the wealthy prescription-drug coverage? We now spend 35 percent of the budget on seniors, many of who are wealthier and have more income than the people who support Medicare and Social Security. That percentage will increase to 43 percent without a drug benefit, most of which will go to people who can afford to pay for their own drugs.

If Gore has his way, we all might be walking along the roadside collecting cans to pay the payroll tax to pay for the prescription drugs for wealthy seniors. I hear all that bending over is good for the heart. With all the limits on choice we're going to need to pay for Al's Medicare drug plan for rich seniors, getting sick will not be an option.