Intrusive health care

Posted: Jun 26, 2003 12:00 AM

WASHINGTON -- Desperate to control the congressional embrace of prescription drug subsidies, the House Republican bill would apply means testing to catastrophic illnesses. That laudable effort, however, carries an unexpected consequence. The health insurance industry would have access to the income data of every senior citizen in America.

So much for supposed congressional concern about privacy. Ironically, this massive intrusion into secrets of older citizens results from Rep. Bill Thomas's attempt to prevent ideological disaster for the Republican Party flowing from its perceived political triumph of getting rid of the issue. The innovative Ways and Means Committee chairman's proposal for means testing is part of his drug subsidy plan, which provides reform elements missing from the Senate version.

Grumbling from the conservative base is rising as the Republican-controlled Congress and the Republican administration agree to subsidies without real reform. That fits the long-range agenda of Sen. Edward M. Kennedy, the Senate's liberal lion who has become a fox in moving inexorably toward government control of health care. Supposed carping from his left should not be taken seriously. Kennedy is happy with the administration-blessed Senate bill, which threatens future private participation in prescription drug programs.

What Kennedy does not want is Thomas's bill, which at least makes an effort to give seniors a private sector option. Its intrusiveness, however, shows what can happen when market-oriented Republican legislators institute a new entitlement.

The Thomas bill's provisions dealing with catastrophic illness provide federal payments once a senior citizen's annual out-of-pocket drug expenses exceed $3,700. However, for persons with an adjusted gross income over $60,000, the amount of the senior's expenses needed to qualify for aid would gradually rise under a formula until the person's income reached $200,000.

But how could this be administered? The bill spells it out. The Health and Human Services (HHS) department would give the Treasury the taxpayer identification number of everybody participating in the prescription drug program. Treasury would then inform HHS of each citizen's income. HHS next would compute who qualifies for how much aid, informing health insurance companies and pharmacy benefit management firms. These private companies could then easily calculate the income of every participant in the drug program.

Because the means testing is new, it is doubtful many members of Congress are aware of this prospective government intrusion. Even without that knowledge, conservative Republicans in the House are wary of voting for legislation much like past measures they supported because this time the bill will pass. It will pass thanks to a calculated decision, once and for all, to take the prescription drug issue away from the Democrats.

As he did two years ago on the education bill, President Bush called for bipartisanship -- meaning a bill that is satisfactory to Teddy Kennedy. This has dovetailed with passionate demands by Sen. Bill Frist, experiencing rough seas on his maiden voyage as majority leader, for passage of health care legislation by the Fourth of July.

A national Zogby poll taken for the Galen Institute June 18-21 shows that 82 percent of likely voters would like a private health option for drug benefits but that 74 percent consider the Senate plan worse than present coverage. The Senate plan's details are loaded against private participation. In her newsletter for Galen, conservative health analyst Grace-Marie Turner says the Senate plan is based on the same "flawed . . . system that has driven Medicare HMOs out of business and is forcing more and more doctors to refuse to see patients on traditional Medicare."

Former Senate Republican Leader Trent Lott paid a recent visit to the always-closed sessions of the conservative GOP Steering Committee to complain about the party's drift. Lott is part of a movement by senior Republicans -- led by Sen. Jon Kyl, chairman of the Republican Policy Committee, and including Sens. Don Nickles and Judd Gregg -- to add a reform component to the Senate bill.

Without help from President Bush and Majority Leader Frist, however, what Grace-Marie Turner calls the "Medicare steamroller" will not slow a bit. Instead, Kennedy can rejoice that the days of private health care options in America may be numbered and laugh that the Republican effort to prevent this would threaten the privacy of older Americans.