After his failed health-care proposal turned into the major political disaster of his first term, President Clinton has now drawn a line in the sand over the relatively meaningless issue of providing a new, $118 billion prescription-drug benefit for all Medicare recipients. The president who once sought universal health-care coverage for all Americans has chosen to flex what's left of his political muscle to extend benefits to the elderly -- two-thirds of whom already have some drug coverage. "I don't intend to give up the battle until it is won," Clinton vowed righteously on Monday.
Like a clueless fireman, Clinton seems intent on directing his high-powered hose at a smoldering weenie roast while an out-of-control forest fire blazes all around him. There are at the moment more than 11 million children in America living not just without prescription drug benefits but without any health insurance at all. And despite the thriving economy, things are only getting worse: The percentage of uninsured children rose to 15.4 percent last year. Among poor children under age 6, nearly one in four has no insurance.
"The moral test of government," said Hubert Humphrey, who helped establish Medicare 34 years ago, "is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those in the shadows of life, the sick, the needy and the unemployed."
If that's the case, our health priorities have definitely been stuck in the Twilight Zone. And if you wonder why we've done a much better job taking care of our senior citizens than our children, the answer is provided by the Committee for the Study of the American Electorate: Voting by those 65 and older is actually going up, while turnout at the other end of the age scale continues to plummet. And, of course, children can't vote at all.
In other words, Clinton's latest battle is more about filling ballot boxes than filling prescriptions. "Democrats lost senior men in '94 and '96," said Democratic pollster Celinda Lake. "Even more important, 1998 was the first time that Democrats have lost senior women. We have to get that constituency back." It's no wonder that Bill Bradley and Al Gore are vying for this prized voting bloc with their own competing proposals for the most unlimited prescription drug coverage.
Maybe the answer is for poor, uninsured kids to organize and create a junior version of the AARP -- the FVA (Future Voters of America); or, perhaps, the FTA (Future Thugs of America). Their motto could be, "Help us now -- or we'll make your retirement very unpleasant!"
Not only is the focus on more prescription drugs for the elderly a misguided priority, it also overlooks the fact that according to a study by the Journal of the American Medical Association, 6.6 million elderly Americans were actually being overdrugged -- prescribed too many drugs or inappropriate ones that "placed them at risk of such adverse side effects as memory loss, the inability to think clearly, and sedation, leading to falls and serious injuries."
In his speech announcing the first federal survey of prescription drug prices, the president cited as an example "one of the most popular drugs for lowering cholesterol," which costs $44 for 60 tablets in Canada, but $102 in the States.
"Today," Clinton said, "prescription drugs can accomplish what once could be done only through surgery, at far less pain and far less cost." But the president and most politicians dealing with health care are living in the past. Just a couple of days earlier, Dr. Dean Ornish, founder and director of the nonprofit Preventive Medicine Research Institute, was conducting a bipartisan retreat with congressional leaders to introduce them to his revolutionary -- and clinically proven -- concept that a program of diet, exercise and lifestyle changes can often accomplish what is now being done through surgery and drugs.
It is the first program of its kind to demonstrate a reversal in cases of severe heart disease, the No. 1 killer of Americans. For five years Ornish has fought to make his program an option available to Medicare recipients as an alternative to more expensive and dangerous medical treatments. The good news is that the Health Care Financing Administration, with the president's support in this case, has finally agreed to fund a demonstration project for up to 1,800 Medicare patients with coronary artery disease.
"We must focus on health care, not just disease care," Ornish told me. "Drugs frequently can be avoided if people make changes in lifestyle. We need to teach the elderly how to do this. It would be more compassionate, more competent and more cost-effective."
Rep. Charles Rangel, D-N.Y., who, together with his political arch enemy, Rep. Dan Burton, R-Ind., convened the congressional retreat, is enthusiastic. "Clearly, the tens of billions of dollars that we spend on health care is after the fact, after the disease," he told me. "Dean Ornish's demonstration project actually makes surgery unnecessary. But it's going to take a long time to educate this country and turn it around to take a serious look at preventive care."
The alternative is watching exploding health-care costs devour an ever-greater portion of our national budget while more and more people join the ranks of the uninsured. And that would be a very tough pill to swallow.