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John Feehery: Rx drugs: 10 years later

Ten years ago, Congress was in the process of passing a controversial piece of legislation, which the president would sign on Dec. 8: the Medicare Prescription Drug, Improvement and Modernization Act.

This measure somehow survived a series of harrowing, near-death experiences that would have made Bill, of “Schoolhouse Rock” fame (“I’m just a bill, yes I’m only a bill, and I’m sitting here on Capitol Hill”), break down in tears.

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When then-Speaker Denny Hastert (R-Ill.) introduced H.R. 1 to the House in the heat of Washington summer, he knew it was going to be a heavy lift. House Minority Leader Nancy Pelosi (D-Calif.) made a political decision not to cooperate with the Republicans and demanded that her rank and file stay disciplined, making a truly bipartisan bill difficult to achieve. Hard-core conservatives were not comfortable with improving the Medicare program with a prescription drug benefit, making it all the more difficult for the Speaker to deliver the votes.

But Hastert knew the American healthcare system inside and out, and he knew that modernizing the Medicare system with a drug benefit would not only be politically popular, it would also save lives — and if done the right way, could point the way to future Medicare reform.

In the early 1990s, Hastert had been appointed by Rep. Bob Michel (R-Ill.), who was then House minority leader, to lead a healthcare task force, and had been the House Republican point person to come up with an alternative to Hillary Clinton’s healthcare reform plan when Bill Clinton assumed the presidency. Thanks to Hastert’s efforts, House Republicans were able to stop the Clinton juggernaut by coming up with a plan that proved to be more popular with Blue Dog Democrats than Hillary Clinton’s ideas, and that forced the Democratic leadership to scrap the whole idea.

Hastert later worked with then-Sen. Edward Kennedy (D-Mass.) to come up with a compromise law that protected the privacy of healthcare consumers, provided more healthcare portability and created medical savings accounts.

When Hastert ascended to the Speaker’s office in 1999, he was well-prepared to handle the next pressing issue to face the healthcare system: a prescription drug benefit for senior citizens.

The fact that Medicare did not have a drug benefit when it was created was more of a function of when Medicare was founded, and had less to do with a need for the benefit. In 1965, drug therapy was not nearly as important to patient care as it is today. But by 2000, drugs had become a lifeline for millions of senior citizens.

The talking point for both sides of the political debate was powerful: Senior citizens shouldn’t have to choose between paying their mortgage and paying for their life-saving drugs.

Purists would have you believe that the free market could easily take care of that problem without the government’s help, but to most Medicare patients, there was scant evidence of that theory. And in fact, back in 2000, drug costs made many life-saving drugs unattainable to many older Americans.

Democrats, who had done nothing to fix this problem in the 30 years they controlled the Congress after Medicare was enacted, had a simple solution, which was basically a government takeover of the drug industry with strict price controls.

Their bill would have cost taxpayers a trillion dollars but would have had a negative impact on innovation and quality in the drug marketplace.

Republicans, led by Hastert, pushed a market-based approach that would cost less, increase competition among drug manufacturers and insurance companies, and give consumers many, many more choices.
Somehow, the Speaker was able to forge a compromise with Kennedy that easily passed the Senate. The House was a different story, as both the initial bill and conference report passed with great difficulty, the latter requiring that the vote be held open for three hours.

After the vote concluded, Hastert told the press, “They criticize me for keeping the vote open for so long, but I have been working on this issue for 20 years, and seniors have been waiting through three Congresses for a prescription drug benefit. So, I don’t think waiting three hours to get it done is too much.”

And it turned out, he was right. Ten years later, the Medicare Part D program enjoys widespread support.

According to the Kaiser Foundation, 63 percent of the American people favor the program, compared to only 14 percent who don’t.

Feehery is president of Quinn Gillespie Communications and spent 15 years working in the House Republican leadership. He is a contributor to The Hill’s Pundits Blog and blogs at www.thefeeherytheory.com.