Congress should give Medicare legislation a chance to work<br>

As a physician who has Medicare beneficiaries among my patients, I was among the many whom believed that this legislation would make it easier for seniors and the disabled to lead longer, healthier and more meaningful lives.

Unfortunately, before the law is even implemented, some members of Congress are back-tracking and seeking to overturn key provisions—apparently in an effort to score political points, at the expense of needy seniors and the disabled.

The Capitol Hill news publication Congress Daily summed up what is happening in a recent article in which it said that House Minority Leader Nancy Pelosi and Senate Minority Leader Tom Daschle plan to introduce legislation “to repeal the provision of the [Medicare] law that bars the federal government from negotiating directly with drug companies for lower prices.”

Legislative insiders call this the “non-interference” provision of the law because it specifies that the government “may not interfere with the negotiations between drug manufacturers and pharmacies and Prescription Drug Plan sponsors” and “may not require a particular formulary or institute a price structure.”

I call it plain common sense.

I do so because from a medical standpoint, this part of the law is key. This part of the bill protects patients by keeping the government out of decisions about which medicines they will be able to receive.

Under this section, the Center for Medicare and Medicaid Services, the government body that oversees these programs, will not be able to dictate that drugs must be excluded from a Prescription Drug Plan formulary or subjected to reimbursement limits that effectively deny access. This provision is fundamental to the consumer-choice, private-market mechanism established by the new law. It relies on a competitive model to deliver a benefit that gives our seniors choices among plans and drugs at affordable prices.

This competition will mean private plans will have strong incentives under the law to negotiate the best possible deals on drug prices, because they are at risk for a large part of the cost of the benefit. They also will have the market clout to obtain large discounts. By driving hard bargains, they will be able to offer lower premiums and attract more enrollees. Obviously the Medicare beneficiaries—some of them my patients—will be the winners.

The alternative is a command-and-control system that would not be responsive to consumer desires or marketplace realities. Bureaucrats would swing between adding benefit requirements without a means of paying for them and restricting choices and access in an effort to contain costs. This is exactly what has happened in other countries, which have nationalized health care plans. The new Medicare law wisely rejects that approach, and the non-interference provision is the fundamental protection against it.

It is both sad and puzzling that the non-interference section of the law would come under attack now from some members of the Democratic Party. After all, this provision was created by the Democrats and first appeared in May 2000 in a bill sponsored by Senator Daschle and 33 Democratic co-sponsors. As Congress continued its work to revise the Medicare law during the ensuing years, the same language stayed in most drafts of the bills—again with Democrat backing.

Why would these same officials retreat from this concept now? From my perspective as a medical professional it simply doesn’t make sense.

The new Medicare law was passed with both Republican and Democrat support from across the political spectrum. Now just at a time when health care professionals and Medicare officials are gearing up to follow the will of Congress to make the law real and meaningful for seniors, a few in Congress are seeking to undermine those efforts. Public officials should not play politics with the lives and health of seniors in this fashion.

(A clinical endocrinologist specializing in diabetes, Dr. Richard Dolinar is a member of the largest endocrinology group practice in Phoenix.)

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