Drug Plan Debate Focuses on Wealthy
By LAURA MECKLER
WASHINGTON (AP) — More often than not, discussion of requiring the wealthy to pay more for Medicare comes to this: Why should the taxpayers help Bill Gates pay for his health care?
House Republicans have a simple answer: They shouldn’t be helping Gates, who ranks as the wealthiest American – at least not as much as they help middle class seniors, and certainly not as much as they help the poorest.
Democrats and others worry that using income to determine benefits would change Medicare from an entitlement into welfare and widespread support for it would soon diminish.
The GOP Medicare prescription drug plan being considered on the House floor this week would, for the first time, link Medicare benefits to income. It would require those with incomes above $60,000 per year to spend more before the government begins paying the full cost for those with very high drug costs.
Supporters say it’s only fair to target the limited dollars available to those who need help most. Some argue that income tests will be essential once the baby boomers begin retiring and Medicare heads closer to bankruptcy.
Most of the opposition comes from Democrats – hardly traditional defenders of the rich.
“I am concerned that the means testing provisions of the bill depart from Medicare’s commitment over four decades to help all seniors, regardless of income,” wrote Sen. Edward Kennedy, D-Mass., in a letter outlining his objections to the House bill. “All workers pay into the Medicare trust fund, and all retirees should benefit from it.”
Kennedy is supporting the Senate bill, which has no such provisions included.
House Republicans conducted polling that found the public would support their plan as long as the threshold was set at a relatively high income level.
Senators have supported a similar concept in the past. In 1997, the Senate Finance Committee voted overwhelmingly, 18-2, to require that seniors with higher incomes pay higher deductibles before getting their doctor visits paid by Medicare. The provision was dropped before the bill became law.
Senate Minority Leader Tom Daschle, D-S.D., left the door open to including the means test in the final Medicare bill, saying the provision is likely to complicate and add overhead to the program – but not ruling it out. “We wouldn’t support a means test at this time,” he said.
For supporters, it’s a matter of both fairness and dollars.
“We’re trying to use the generous resources the American taxpayer gives the government wisely,” said Rep. Dave Camp, R-Mich. “Why should Bill Gates have a government-supported prescription drug benefit?”
The answer: Because Bill Gates is paying into Medicare as a worker, said Rep. John Dingell, D-Mich., dean of the House and longtime defender of Medicare. “I don’t have any trouble with that,” he said.
“I don’t like this Republican class warfare anyhow,” Dingell added. “I think we ought to take care of everybody.”
Premiums and deductibles for poor seniors have long been subsidized by the government, and the drug benefit would include extra help for lower-income seniors.
The House bill also limits benefits for upper-income seniors. Under the bill, there is a gap in drug coverage. The government would pay 100 percent of all costs but only after someone spends $3,500 of their own money.
For seniors with incomes above $60,000 ($120,000 for couples), that threshold would rise, until it hit $12,000 for those who make $200,000 and up.
The idea has died in the past because it did not raise enough money to justify the political heat, said Gail Wilensky, a Medicare expert who ran the program under the former President Bush. She predicted financial calculations will change as the baby boomers begin retiring, and financial pressures on the system grow.
“It’s potential for the future is substantial,” Wilensky said. “It’s an important precedent, which is why some like it and others hate it.”
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