Nathan, you are as wrong as you can be. I posted my response to you over at daily kos. Let me add to that that rolling over on this one will give Bush a victory he will trumpet in TV ads to show that he is really a "compassionate conservative." When, in reality, he is just using this to further dismantle the social safety net. And he will use this "victory" as support for his effort to privatize Medicare.

Paleo - I was going to post a long answer here, but read your note that you've commented. I'd to read yours before I post mine in case you've already said everything I intend to. I went to Daily Kos. Could not find yours.What thread is your comment under?

My email address is GarLpublic ***A***T*** *C**o**m*c****a*s*t* *d**o**t **n*e**t . Ignore the asterisks and spaces, and replace the word 'at' and 'dot' with appropriate symbols.

Well I'll make two comments regardless:

1) Your conclusions would follow if your premises were not wrong. I don't think this is an inadequate bill; it is on balance a BAD bill. Specifically the privatazation outweighs the benefits of the extra money. In terms of "Oh we can repeal the privatization aspects before they take effect". It is a lot easier to STOP something bad from passing than to REPEAL it. Even without majority control the Democrats have the power of filibuster to stop it. Once passed, even if the demos take control of both houses and the Presidency, a minority of Republicans could prevent repeal with a filibuster. In short if you believe the Democrats will end up with Presidency and at least one house at the same time sometime this decasde, you should not be supporting the passage of this bill.

2) In terms of the AARP - the AARP has a conflict of interest here. Insurance sales are a major source of their revenue. I would not count on them representing their constituents interests 100% on health care issues of any sort.

The thread is currently number 36: "Pass the Medicare bill."

I agree with both of your points, Gar.

The competition part is one thing. However, the bill as I understand it games the system for insurers and big pharmaceutical companies. The bill doesn't allow medicare to setup a formulary and be able to negotiate prices with the drug companies. Medicare (and we as taxpayers) have to pay whatever the pharmaceutical companies want to charge (probably not too shabby for their bottom lines considering that the 70% of seniors who currently have prescription drug coverage are covered by formularies). Insurance companies, state medicaid, Canadian provinces, the VA and federal government employee plans all maintain formularies to negotiate discounted prices with pharmaceutical companies. In fact, the VA is one of the lowest cost buyers of drugs in the world. Forcing Medicare to compete with one-hand tied behind it's back against insurance companies can only lead to one result.

Manish- As long as Medicare isn't paying for prescription drugs, there will never be serious pressure to force down drug prices. But if they do start paying for it, it will give Dems an irresistable weapon to push through the next round of reforms-- pass a bill, cut prescription prices, and expand benefits, all with no or minimal increases in overall costs.

My basic political judgement is that we will be better positioned for the next round after passage than now because of those cost pressures. So in the short-term, we get a benefit for seniors and in the long-run, it builds political pressure for the real reforms we all know are needed.

I just don't think that saying no gets us there faster than passing this bill. It's a strategic judgement, but I think I'm right.

E.J. Dionne totally destroys the bill:

"The problem is that many conservatives, especially in the House, don't like Medicare as it is. They would prefer a system in which the government guaranteed everyone a certain amount of money that could be used to buy private health insurance. Ending Medicare as we know it is their long-term goal. They call this "expanding choice."

Most Democrats and many Republican moderates say this is a dangerous illusion. As it stands, Medicare guarantees the real choices most seniors care about -- a choice of doctors and treatment. That's why experiments with HMOs have failed so far.

The virtue of Medicare is that it creates a large risk pool. The wealthy and the healthy are in the same boat as the poorer and the sicker. Busting up Medicare's risk pool would almost certainly raise costs to poorer and sicker seniors, as insurance companies make more money insuring healthy people than sick ones. It would take an enormous amount of regulation to prevent this sort of "cherry-picking."

Now, what does any of this have to do with a prescription drug benefit? Good question. If this were only about providing a limited prescription drug benefit, Congress could have debated the best ways to cut up the $400 billion it has allocated for this purpose. The amount covers a little more than a fifth of seniors' drug costs. Logically, this limited sum would have been best used to help the poorest seniors who are not now covered by Medicaid, and the sickest -- those whose drug costs are especially high.

Instead, Republican negotiators, joined by Democratic Sens. John Breaux and Max Baucus, went behind closed doors and decided to use the public's demand for drug coverage as an opening wedge to change Medicare. The shame of it is that Republicans and Democrats in the Senate had already reached a real compromise. The bipartisan proposal, crafted in cooperation with Sen. Ted Kennedy, was inadequate. Yet it was better than this bill. It passed the Senate overwhelmingly because it left the larger Medicare issues open for real debate later.

But House conservatives weren't willing to go that far. They want medical savings accounts, a tax cut for the wealthy in disguise, and they insisted on experiments with privatization.

But if privatization is such a good idea, why do the private insurance companies need such big subsidies to enter the Medicare market? The bill includes $12 billion for what Kennedy calls a "slush fund" to subsidize the private insurers. That's not capitalism or competition. It's corporate welfare.

"They've created a huge bias in favor of private plans," says Jeanne Lambrew, senior fellow at the Center for American Progress and a professor at George Washington University. "How can you call it choice or competition when private plans have such a large financial advantage?" And a bill that is supposed to expand drug coverage may cause at least 2 million seniors to lose their coverage from their former employers, Lambrew said."

http://www.washingtonpost.com/wp-dyn/articles/A54786-2003Nov17.html