WASHINGTON -- As Congress reconvenes this week, conservatives are pushing a scenario that makes the best of inevitable prescription drug subsidies: The Senate-House conference would retain the House bill's market elements. That would collapse the Senate's big bipartisan majority, perhaps producing a 50-50 tie to be broken by Vice President Dick Cheney. There may be, however, a surprising obstacle: George W. Bush.
The White House has made clear the president will sign any prescription drug bill arriving from Capitol Hill. Bush thereby has removed himself as a player in an epochal battle over this country's health care, undermining the optimistic scenario. No realistic conservative can devise a way to kill this bill. The question is whether Sen. Edward M. Kennedy's inexorable march toward a government-controlled health care system can be slowed.
The president does not seem at all interested in this effort. Indeed, on no issue has he been so separated from his conservative support base. He did not please supporters when he collaborated with Kennedy on the 2001 school bill or said he would sign any campaign finance reform bill in 2002. But Bush's passivity on prescription drugs, abandoning his own stated intentions, casts a longer shadow on national policy. Republicans do not want to criticize their president as the election campaign nears, but they are heartsick.
Two battles have been lost irrevocably and in fact were lost from the start. First, a massive new entitlement of prescription drugs for seniors will be established, with its real cost around $1 trillion over 10 years. Second, Medicare -- which approximates a national system of socialized medicine -- will not be reformed comprehensively as part of a prescription drug subsidy (as hoped for by nearly all Republicans, George W. Bush included).
Unlike the Kennedy-blessed Senate bill, the House measure does provide a vestige of Medicare reform: a workable market-based option for providing prescription drugs. In the Senate, Kennedy made sure the private sector was effectively excluded.
A second saving feature of the House bill typifies the legislative creativity of House Republicans, a missing factor in the Senate and the administration. Three weeks before the legislation hit the House floor, Majority Whip Roy Blunt's office worried that the prescription drug bill would not pick up enough conservative support to pass. To improve the product, the old, limited Medical Savings Accounts, under which individuals would establish tax-exempt nest eggs for emergencies, were dressed up and rolled out.
A separate bill sponsored by Rep. Paul Ryan, a supply-side Republican on the House Ways and Means Committee, changes the name to Health Savings Accounts (HSA) and broadens the coverage. This bill passed the evening of June 26, before the prescription drugs measure was brought up. It was fiercely opposed by Democrats, who have always been antagonistic to private accounts.
But HSA opponents may have been asleep at the switch earlier that day when Rep. Deborah Pryce, Republican Conference chairman, told the House: "Upon passage of both pieces of legislation, the text of HR 2596 (HSA) should be added as new matter at the end of HR1 (prescription drugs). In simple terms, these two bills will become one."
Oddly, no Democrat protested. By itself, the HSA would have tough going in the Senate. Folded into prescription drugs, it now enters a Senate-House conference. The question becomes whether this market-oriented proposal will survive that Senate-House conference.
On the day after the Senate passed the Kennedy-approved bill, Democratic Sen. Debbie Stabenow went to the floor to state the liberal position. Stabenow, who relentlessly promotes government health care, declared her vote for the bill was "one of the toughest" since her election from Michigan in 2000. If the House bill ends up as the final product, she promised, "I will vote no."
In short, Debbie Stabenow's support is based on killing the House's market elements, but the White House gives the impression the president does not care if they die. That would not be the case if he listens to Medicare Administrator Thomas Scully, who understands the stakes for American health care. The correct perception on Capitol Hill is that the president's political team wants to get this over with, sign any bill, and damn the consequences.