April 7, 2002
A Health Care Revolt, Remembered
By FRED BROCK
Before Sept. 11, momentum had been building for Congress to pass some form of prescription drug coverage for Medicare recipients. But that and other domestic issues were put on hold after the attacks and the start of the Bush administration's anti-terrorism campaign.
But now, more than six months later, prescription drug coverage is back on the front pages, thanks to the forces of rising drug prices and election-year politics.
And the Dan Rostenkowski factor.
In the summer of 1989, Mr. Rostenkowski, then a congressman from Illinois and the powerful chairman of the House Ways and Means Committee, was besieged by a crowd of 50 senior citizens in Chicago. According to The Chicago Tribune, the protesters-shouting "coward," "recall" and "impeach"-forced him to sprint through a gas station to his car, where minutes earlier an elderly demonstrator had been sprawling across the hood.
The protesters were angry about a new law that provided catastrophic coverage for Medicare recipients, but with an income-tax surcharge of up to $800 a year that was set to rise to $1,050 in 1993. That law was soon repealed. But the television images of Mr. Rostenkowski under assault struck fear in the hearts of politicians that remains to this day. Few want to be pitted against older people on issues involving Medicare.
"Politicians were traumatized by the Rostenkowski episode and they remain traumatized," said Henry J. Aaron, a senior fellow at the Brookings Institution.
Amanda McCloskey, director of health policy analysis for Families USA, a nonprofit consumer advocacy group for health care concerns, says anger among seniors over this issue is building again as the events of Sept. 11 recede. "Many seniors are desperate over trying to afford prescription drugs," she said. "We see them ordering drugs over the Internet from Canada, where drugs are cheaper, or taking bus trips to Canada for prescriptions.
"The notion of people making decisions over buying groceries or prescriptions is accurate, especially for those who have to live mainly on Social Security benefits," she added. "Remember, people with no coverage are forced to pay full retail for their prescriptions."
According to the 2000 census, people 65 or older-those eligible for Medicare-are 12.4 percent of the American population. But they account for 34 percent of all prescriptions filled and 42 percent of the money spent on prescriptions, Ms. McCloskey said. Families USA estimates that one-third of Medicare recipients have no prescription coverage. Many others are without coverage for part of the year because they have exceeded the limits on their so-called Medigap policies or prescription provisions in their Medicare health maintenance organizations.
Oxford Medicare Advantage, the H.M.O. of Oxford Health Plans (news/quote) that operates in New York City and parts of New Jersey and Connecticut, began running a series of stark television commercials in March. In them, its members stand up, face the camera and say "I demand" things like prescription coverage. The ads are aimed at luring those enrolled in traditional Medicare to Oxford, which offers limited drug coverage.
But the ads have an interesting subtext of militancy that some could see as harking back to the Rostenkowski episode. "Militancy and anger on the issue of prescription drugs is out there," said Peter D. Haytaian, vice president for government programs at Oxford. "But it's not been publicized much. It's been held back by the media and clouded by other high-level H.M.O. issues like a patient's bill of rights."
Of course, Oxford and other for-profit H.M.O.'s have a clear self-interest in any increased spending for Medicare.
Mr. Aaron of the Brookings Institution said the pressure to add prescription benefits to Medicare would increase as more and better drugs became available from pharmaceutical companies. "These new drugs do wonderful things, but they cost a lot," he said. "People are going to want to have them."
He suggested that prescription coverage could become the sugar coating for an otherwise bitter pill in overhauling Medicare: forcing middle- and upper-income recipients to pay more out of pocket for care.
"This will depend on centrist support from both parties," he said. "If that doesn't happen, it'll be a political football. It isn't clear to me that we're going to have a window for reform before the next presidential election. Politicians haven't really gotten serious about prescription drug coverage. But they're good at reading the grass roots; this issue could become a very lively one."
One group that might make it lively is the 70 million or so baby boomers, the oldest of whom will hit 65 in less than 10 years.
Many think this self-absorbed generation, which is known for spending instead of saving, will use its political muscle to force changes in social programs like Medicare to benefit its members. After all, this is the war-protesting generation that chased Lyndon Johnson out of Washington in the 1960's.
BUT Neil Howe, the co-author of "Generations: The History of America's Future, 1584 to 2069" (William Morrow, $16), doesn't think so.
While he agreed that their numbers would give them some influence, "boomers are not particularly effective politically, as an organized lobby for their own collective benefit," he said.
"As old people, they will dominate the culture and they will have a lot of personal passion," he said. "But that will not translate into anything that's politically effective."
He added: "They were throwing rocks in the 1960's because they had no power. But the way you express yourself when you're young and out of power is very different than when you're old and in charge of institutions."
So we can't expect legions of elderly boomers to take to the streets, 1960's style? "No, but they'll complain and whine a lot," Mr. Howe said.
That should be music to the ears of politicians who remember Dan Rostenkowski.