5he tangle of bills and sub-bills, the rhetoric of imperatives and velleities swirling about Congress, remind us of the evanescence of conservative doctrine. What happened, of course, is that in the presidential election of 2000, the Democrat, Mr. Gore, promised he would bring free drugs to the aging population. The winner, Mr. Bush, wants to preempt future charges that he did not come up with a program of his own.
Politics that involve the disbursement of money are exercises in redistribution. Free medicine, as defined in this space years ago, is medicine that somebody else pays for.
Conservative analysis begins by attempting to trace the itinerary of dollars on a nationwide scale. John Esposito, a 65-year-old who has been earning $35,000 per year and is now paying $400 per month for prescription drugs is, emblematically, the object of concern. How to help him out?
He can't be helped out except by taking from others. If government steps forward with a program to reimburse him one half of his $400 monthly expenditure on drugs, the net subsidy of $200 has to be found. Where?
One means, of course, is by borrowing. You pay his drug bill and sell Treasury bonds to make up the cost (estimated, in static analysis done on the pending bill backed by President Bush, at $400 billion over ten years). Or you can devise creepy-crawly taxes that contribute to the treasury sufficient to offset the extra expenses. Most notorious of these is the tobacco tax, but there are others, including tariffs and, of course, the income tax. But immediately to impose on Esposito a $200 per month increase in income tax quite ruins the apparent advantage he thought he was getting out of the drug bill.
Another approach is to attempt to lower the cost of those drugs. This is difficult to do except to the extent that the administrative cost can be trimmed. Enter the Republicans, who favor running as much of the dollar traffic as possible through private health plans. There are options on the table in Congress on the distribution of benefits, on the contributions expected from John Esposito, on the upper limits of the cost of drugs he can be covered for, and so on.