Presumptive GOP Presidential Nominee McCain Proposes Higher Medicare Drug Benefit Premiums for Higher-Income Beneficiaries

Presumptive Republican presidential nominee Sen. John McCain (Ariz.) on Tuesday during a speech at Carnegie Mellon University plans to announce a proposal that would require higher-income Medicare beneficiaries to pay higher monthly premiums for the prescription drug benefit, the Washington Post reports (Shear/Weisman, Washington Post, 4/15). Higher-income Medicare beneficiaries currently pay higher premiums for Part B, which covers physician visits and outpatient hospital care, but all beneficiaries pay the same premiums for the prescription drug benefit.

Under the proposal, individual Medicare beneficiaries with annual incomes that exceed $80,000 and couples with annual incomes that exceed $160,000 would pay higher premiums (Meckler, Wall Street Journal, 4/15). McCain aides said that he would announce more details about the proposal, such as the amount that premiums would increase for higher-income Medicare beneficiaries, at a later time (Washington Post, 4/15).

McCain said, "People like Bill Gates and Warren Buffett don't need their prescriptions underwritten by the taxpayers." He added, "Those who can afford to buy their own prescription drugs should be expected to do so" (Wall Street Journal, 4/15). According to Carly Fiorina, a top adviser to McCain and a former CEO of Hewlett-Packard, the proposal would save billions of dollars. She added, "When we added the prescription drug benefit ... we included a lot of people that can well afford to pay for their own prescription drugs." Douglas Holtz-Eakin, chief policy adviser to McCain, said, "You could make this as aggressive as you want to get more savings."

Democratic National Committee spokesperson Damien La Vera said, "His answer for people struggling with skyrocketing drug prices is to make some people pay more?" In a statement, DNC said that the health care proposals announced by McCain are "copies of President Bush's" and would fail to "reduce the ranks of the uninsured" and "leave people with pre-existing conditions uninsured" (Washington Post, 4/15).

Comparison of Clinton, Obama Health Care Proposals
Democratic presidential candidates Sens. Hillary Rodham Clinton (N.Y.) and Barack Obama (Ill.) have proposed similar health care proposals, and some experts maintain that "this is not the issue that will help voters decide" between them, the Philadelphia Inquirer reports.

According to the Inquirer, both candidates would "build on the current mix of public and private health insurance to make coverage universal and affordable," offer tax subsidies to help residents purchase health insurance, mandate that health insurers cannot deny coverage to applicants with pre-existing medical conditions and limit health insurer profits. In addition, both candidates would require most employers to offer health insurance to employees or pay into a federal fund to provide coverage and allow residents and small businesses to "join big groups to buy private insurance or a Medicare-like public plan," the Inquirer reports.

The most significant difference in the proposals involves the question of whether to mandate that all residents obtain health insurance. Clinton would implement such a mandate, but Obama would require coverage only for children. According to Clinton, Obama would leave 15 million residents without health insurance. Obama has disputed that number and has said that most residents lack health insurance because of cost issues, not because they do not want to purchase coverage.

Kaiser Family Foundation President and CEO Drew Altman said that the differences in the proposals "mean much more to experts than to voters" (Burling, Philadelphia Inquirer, 4/15).

Opinion Piece
Clinton, Obama and McCain all support "ramping up federal funding for so-called 'evidence-based medicine,'" but such programs are "largely driven by the political imperative to cut costs -- not the medical imperative to give patients the best care possible," Peter Pitts, president of the Center for Medicine in the Public Interest, writes in a Washington Times opinion piece. Clinical trials conducted by the federal government to determine whether medications are "effective enough to justify their price tag" take a "one-size-fits-all" approach that assumes the "same care can be applied to every patient suffering from the same disease," Pitts writes.

According to Pitts, health care professionals should have the "autonomy to tailor their treatments to the specific needs of their patients," but evidence-based medicine programs "rarely provide that autonomy" and result in higher costs in the long term. The "theory behind and the practice" of evidence-based medicine programs "just don't match up," Pitts writes, adding, "And until politicians can show how they'll resolve that tension, they need to look elsewhere in their quest to find politically palpable solutions to the country's health care woes" (Pitts, Washington Times, 4/15).