Senate Can't Fill Rx For Medicare

The Senate Tuesday defeated two rival Medicare prescription drug plans, prompting a flurry of talk of compromise to avoid another election-year stalemate on a health policy crucial to America's seniors.

Both a plan backed by most Democrats and a competing plan backed by most Republicans, a few Democrats and an independent were killed on mostly party line votes.

The Democratic plan cost more and relied more on a traditional government benefit model, while the Republicans' was cheaper and had a bigger role for private sector insurers.

Everyone's promising to find a compromise, but CBS News Chief Washington Correspondent Bob Schieffer says don't bet on it. The congressional elections are just months away and all sides have an issue: Democrats can blame it on Republicans, Republicans can blame it on Democrats and the White House can blame it on Congress.

Key lawmakers acknowledged that a compromise would be a difficult balancing act, creating a hybrid that could merge public and private sector approaches to giving seniors a drug benefit that was affordable to them but would not bust the federal budget.

Lawmakers said ideas being floated include phasing in a private sector plan more slowly, with the government taking a bigger role at first, or perhaps having some form of public and private sector alternatives existing side by side. At this point, most of the talking was among Democrats.

"There are ways to do this, we'll just have to look at the options," said Senate Majority Leader Tom Daschle, a South Dakota Democrat.

But even if Republicans do warm to those ideas, they are likely to resist spending more than the $340 billion 10-year price tag in the smaller of the plans defeated Tuesday. "It is absolutely, unequivocally the ceiling of what we can do," said Senate Republican leader Trent Lott of Mississippi.

The Democratic plan was defeated, as expected, on a 52-47 mostly party line vote, falling short of the 60 votes needed for procedural motions. The other plan fell to a similar procedural motion on a 51-48 vote soon after.

Republicans and Democrats, stuck on this issue since the late 1990s, have been exchanging accusations of using Medicare as a political chip in a congressional election year. But some also fear that voters could get mad at both of them this time around, a dynamic that could grease the wheels of compromise.

"Seniors will be fed up," said Louisiana Democrat John Breaux, a centrist deeply involved in negotiations. "They'll be mad at both parties."

Even without politics in a tightly fought congressional election year, the two sides have deep philosophical differences about how a Medicare drug benefit should be designed, what role private-sector insurers should play, and how much the benefit should cost both the individual beneficiaries and the federal treasury.

Going into Tuesday's votes, most Democrats backed a plan crafted by Sens. Bob Graham of Florida, Zell Miller of Georgia and Edward Kennedy of Massachusetts. It would cost about $421 billion from 2005 through 2010, and be a part of the 37-year-old federal Medicare health plan for the elderly.

The other plan would cost $370 billion over 10 years, including some separate Medicare reforms, and relies more extensively on government-subsidized private insurers.

Democrats said putting the drug benefit in the hands of private insurers is unproven and risky, and does not guarantee benefits. They pointed to bitter experience in some states such as Nevada that have tried their own programs.

But Republicans countered that the Democratic proposal is too big and will place too many restrictions on which of the thousands of approved drugs will be available under the plan.

"It would be rationing of prescription drugs, certainly something we don't want to do," said Oklahoma Sen. Don Nickles, the second-ranking Republican in the Senate.

The entire Medicare debate is being folded into a separate, but related, Senate debate on a bill that would reform drug patent law to make it easier for less expensive generics to compete against brand-name drugs.

The debate is expected to continue for at least a few more days, and generic drug bill is likely to pass, even if no Medicare legislation is wrapped into it.

The House in June passed a Republican-authored Medicare plan that also relies on private insurers. It has not taken up generic drug legislation.