Prescription for Punishment

Now that four prescription drug plans have failed in the U.S. Senate, the question becomes: Who pays—not for the drugs, but for the broken promise?

In the 2000 campaign, both parties made the same promise to seniors. Here's Al Gore, August 28, 2000: "I will pass a prescription drug benefit for seniors. Together, we'll make it happen." Here's George W. Bush, September 11, 2000: "Prescription drugs for seniors are going to be not only a priority, we're going to get something done." What happens now?

We know three things about seniors. One, they vote. And they have an especially large impact on midterm elections, when other people don't vote. In the 2000 presidential election, voters age 60 and older made up 22 percent of the turnout. In the 1998 midterm, they accounted for 28 percent.

Two, seniors swing, at least politically. In the last six presidential elections, seniors voted Republican three times (1980, 1984, and 1988) and Democratic three times (1992, 1996, and 2000). A Democratic trend? Well, no, because in three out of the last four House elections seniors nationwide voted Republican.

The House vote among seniors was crucial in 1998. That was the impeachment midterm, when Democrats upset all expectations by gaining House seats. Seniors swam against the national tide, however, and favored Republican House candidates by a 10-point margin (55 percent to 45 percent). It was because of seniors that Republicans retained control of the House. Seniors, more than any other constituency, were offended by President Clinton's personal behavior.

In 2000, the senior vote for the House reversed and went Democratic, 51 percent to 47 percent. As a result, the House nearly reverted to Democratic control. What propelled the senior vote that year? Concern about prescription drugs and Social Security.

That leads to the third distinctive feature of senior politics. They care, particularly about issues that affect them. The top two issues among all voters right now, according to Gallup, are the economy and the war on terrorism. Among seniors, the top two issues are still Social Security and prescription drugs.

The senior vote is no longer reliably Democratic, as it used to be when it was dominated by the Depression generation. New generations entering their retirement years are not as instinctively Democratic. They continue to vote Democratic when senior benefits, such as Social Security, Medicare, and prescription drug coverage, are uppermost in their minds. But when the "values agenda" dominates, as in 1994 and 1998, seniors favor the GOP.

If angry seniors now feel betrayed on the prescription drug issue, whom will they take it out on? "The House has acted," Senate Minority Leader Trent Lott, R-Miss., pointed out on July 17. "The Senate needs to produce a result." It didn't. After a Senate floor debate that lasted more than two weeks, four plans each failed to get the 60 votes needed to end debate and force a vote on its substance.

On prescription drug coverage, two basic issues are in contention. Should all seniors be covered, or just those with low incomes or high drug costs? And should the coverage be provided by the government or by private insurers? First, Senate Democrats proposed covering all seniors through Medicare, at a cost of nearly $600 billion over 10 years. That Democratic plan got 52 votes on July 23. The same day, the Republicans' $370 billion proposal, which would have subsidized coverage for all seniors through private health care insurers, got 48 votes.

Each party then scaled back its proposal by targeting the benefits to people with low incomes or high drug costs. The targeted Republican plan (price tag: $160 billion) got 51 votes on July 24. The targeted Democratic plan (price tag: $390 billion) got 49 votes the same week. Both parties were willing to compromise on the scale of coverage. But neither party would compromise on whether the prescription drug program should be part of Medicare or rely on private insurers.

In the Democrats' weekly radio address last Saturday, Sen. Timothy P. Johnson of South Dakota blasted the GOP approach, which he said would "force seniors into private drug HMOs rather than create a guaranteed benefit in Medicare." He charged, "The big drug companies joined with the large insurance companies to defeat the Senate Democrats' plan, and their Republican allies listened to them."

Democrats claim to have greater credibility on the issue. Polls back them up. By 50 percent to 33 percent in last month's Gallup Poll, the public said that Democrats would handle the issue of prescription drug coverage better than Republicans. And Democratic voters care about the issue more than Republican voters do. Forty-seven percent of Democrats, compared with 31 percent of Republicans, described prescription drugs as an "extremely important" factor in their vote for Congress this year. And angry Democrats are more likely to vote than defensive Republicans.

One Democratic old-timer puts it this way: "In 1964, I was here in the United States Senate when we had the great debate on Medicare, and in that year, the debate was lost. About seven months later, with a new Congress, we came back in 1965 and passed Medicare. The major intervening event was an election."

That was Sen. Edward Kennedy, D-Mass., on July 11. His fellow seniors were around then. They remember. That's what Democrats are counting on.