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The Senate's prescription problem

Six Democratic senators who could have been pleased with getting a majority vote on a prescription drug bill looked mighty melancholy as they gathered for a postgame press conference. One of them, Debbie Stabenow of Michigan, chair of the special prescription drug task force, looked as though she might have been crying. The others _ Majority Leader Tom Daschle of South Dakota, and the three sponsors of the Democratic bill, Bob Graham of Florida, Zell Miller of Georgia and Ted Kennedy of Massachusetts _ were swallowing hard.

Prescription drug benefits are a defining, not to say holy, cause for Democrats. For the past five years, they have promised seniors _ crossed their hearts and hoped to die if they didn't deliver them. In this season of still sky-high polls for the president, it is practically their reason for being.

They got 52 votes in the Senate, with the unexpected help of one Republican, Peter Fitzgerald of Illinois. But it was not enough. The measure would cost $594-billion over 10 years, and it needs 60 votes to overcome a budget point of order, which restricts that kind of spending.

A rival bill, the brainchild of Democrat John Breaux of Louisiana, ever in search of the center and the attention it brings, would cost $370-billion. For some Democrats, Breaux was checkmated by Sen. Miller, a Kennedy-Graham co-sponsor who rates himself as an Olympic-class center-seeker. He loved the Bush tax cut, which is the reason for the empty till for social programs. Breaux worked with three Republicans, Chuck Grassley of Iowa, Olympia Snowe of Maine and Orrin Hatch of Utah, and independent Jim Jeffords of Vermont, a lineup that enabled him to call his effort "tripartisan." It got 48 votes, four less than the Democratic version, which gave the Democrats some comfort. "At least Bush can't say we stopped a prescription drug bill that had more support in the Senate," grumped one.

Such nuances may be lost in the rocking chairs on the front porches of assisted-living facilities, where they are looking for Democrats to deliver. Democrats are campaigning on the premise that while George Bush is the greatest crusader since Richard the Lion-Hearted, he still needs to be monitored on producing life's daily necessities.

Leader Daschle gamely insisted, at the Democratic wake in the Senate TV and radio gallery, that the fight was just beginning, and he promised prodigies of compromise and cooperation. Negotiations were to begin at once.

Strategically, the Republicans have the high ground. They do not harp on prescription drugs. The House has passed a pale shadow of prescription benefits, guaranteeing full participation of HMOs. That gives Republicans crowing rights on who cares more about seniors.

Democratic senators were remembering the fate of Hillary Clinton's grandiose health care plan, which died on Capitol Hill 10 years ago. Democratic Whip Harry Reid of Nevada was reminiscing that it went down in a showdown that should not be repeated.

During the debate, Sen. Tom Harkin, D-Iowa, derided the tripartisan bill's assets test, which would mean that someone who'd had the foresight to purchase a burial plot worth $1,500 would get thumbs down from the beady-eyed supervisors for the HMOs, whom the populace has never learned to love. Harkin mixed it up with GOP conservative Sen. Don Nickles of Oklahoma, who bridled at Harkin's barb that "it's too bad that you weren't around in 1965 to vote against Medicare."

The tripartisan coalition has put its eggs in the private-sector basket. It retains its pre-Enron faith in the superior efficiency and integrity of business. Sen. Grassley, who is much heeded because he is ranking member of the Finance Committee, declares that Medicare is "old-fashioned."

The anecdotal evidence brought to the Senate is contradictory. Members facing re-election report an overriding interest in prescription drugs, which takes precedence over terrorism in their concerns. Sen. Maria Cantwell, D-Wash., tells of three recent health care meetings where she asked audiences whether they preferred public or private oversight of drug distribution. Of an aggregate of several hundred people, only one put up a hand for HMO provenance.

Grassley retorts that he would like to follow in Cantwell's footsteps and ask a followup question at the meetings: Would you like to have a list of drugs from which you and your doctor could pick, or would you prefer to be limited to the two choices the Democrats offer? He thinks he would win big.

Sen. Paul Wellstone, D-Minn., an embattled liberal who is considered the most endangered of his species in the upcoming elections, says that in his state, the ratio of those in favor of Medicare over the insurance companies is 90 to 10. He suggests that negotiators consider leaving the choice of agency up to consumers. Considering the fundamental clash of ideologies inherent in the drug fight, it may not be a bad idea.

Mary McGrory is a Washington Post columnist.

Universal Press Syndicate