Washington, D.C.— For several years, the machinery of Beltway politics has churned a message of Medicare reform and prescription drug plans.  In fact, the House of Representatives has passed prescription drug bills several times.  From the power base whose “political realities” are sown and cultivated inside the culture of Washington D.C., Medicare has been accused of doing too much or too little since its inception in 1965.  Those that want an increased role for the federal government have an overwhelming advantage over defenders trying to hold the line on the size and scope of government.  A compromise between zero growth and a lot of growth is, well… folks, the government is going to grow.  No matter that Medicare has surpassed Social Security in cost to the taxpayer, or no matter about current budget constraints, a Medicare bill may only be a few weeks from becoming law.

 No matter whom you ask, a Medicare prescription drug bill tops the priority list of our domestic agenda.  President Bush, House and Senate leadership, plus, a deafening cacophony of bitter Democratic presidential hopefuls, all insist that the federal government provide a prescription drug benefit to all seniors.

 It is a laudable goal, no doubt, however, the priority has transformed itself from fundamental Medicare reforms into passing a bill, any bill, regardless of cost or consequences.  The Medicare debate has been twisted so horribly that, as we speak, the Conference Committee is totally committed to bringing a bill that can pass both the House and Senate regardless of the policy. 

 What my first year in Congress has proven to me is that a culture exists in Washington DC that concerns itself only with the ability to claim accomplishments.  The budgeting process itself is partly to blame.  When time came to set aside tax dollars to deliver on promises for a prescription drug plan, the magic number of $400 billion was decided.  Where the $400 billion would come from would be answered later.  Ergo, Medicare reform and the prescription drug plan must fit within this “found” money.  It didn’t take long for the experts to decide that $400 billion wouldn’t cover a prescription drug plan for all seniors.  What follows are months of watering down talk of reforming Medicare.  To make this puzzle come together, Congress must find offsets in Medicare to fund the drug component.  Access to health care and rural reimbursements have all but disappeared as part of the original goal. 

 I supported early efforts of Medicare reform that included competition, remedies for waste, fraud and abuse, plus rewards for cost efficiency and high quality service. However, as one-by-one these provisions were dropped out of the competing versions, I felt as if I were the only one in Washington DC who remembered that saving Medicare for future generations was the original goal that brought us to this point.  Somewhere along the line, the culture of inside-the-beltway politics twisted the debate into a prescription drug bill.

 Moreover, I voted for the House version of the Medicare bill on the promise from leadership that cost-efficiency and high-quality language that I wrote would be introduced to the Conference Committee and considered for its final version.  I understood that the modest rural reforms that were included in both the House and Senate versions were desperately needed by Iowa health care providers.  Yet after considering the impact, I knew that Iowa would still be ranked 50th in Medicare reimbursements.  Something more needed to be done.  Iowa needed an opportunity to move out of dead last.  That’s why I have been pushing cost and quality language.  Iowa’s health care providers have been doing an incredible job regardless of the horribly low reimbursement rates.  No state in the Union can say they have done more with less than Iowa, and it is high time that Iowa is rewarded for its accomplishments.  The resulting language provides under-reimbursed areas a “rate case” before Medicare administrators that considers geographic inequities and requires consideration for quality care.

 It would have been far easier to vote “no” and walk away.  But I determined that I should vote “yes,” stay at the table and try to make a bad bill better.

 It seemed as though everyone supported the delivery of a prescription drug bill.  However, a funny thing happened on the way to Conference Committee.  It is true that the devil is in the details.  Now it seems that no one is happy with it.  The prescription drug component has no cost controls, which is important because no one knows how much it is really going to cost, short or long term.

 Finally, we are finding out how we are going to pay for it.  It appears as though Washington DC is determined to provide a prescription drug program to every senior at the expense of overall health care access.  How can the federal government pay for your prescriptions if you can’t see a doctor in the first place?  Iowans know all too well the problems with access to health care, and Washington seems of a mind to hinder access everywhere else. 

 There are several areas of health care that will pull a short straw in order to provide the drug benefit.  Oncology may well see the reimbursement for cancer drugs cut.  Beneficiaries must provide co-pays for clinical labs work and home health.  The Senate version contains a rule that won’t allow physicians to own any part of a specialty hospital.  Every sector from physical therapy to chiropractic is left without real reforms that can save access.  The other important component in driving down the cost of health care is medical liability reform.  The House passed liability reform earlier this year, but it shows no signs of life in the Senate.

 My staff and I will continue to work on the Conference Committee with the intention of bringing real reform to the final package.  Medicare is our top priority as it is as much an economic development issue in Iowa as it is a health care issue.  Access, affordability, rewards for cost-efficiency and high quality health care are the cornerstones of my approach.  Entitlements for Bill Gates, Steve Forbes, and Warren Buffet are not.   

###