WASHINGTON – Tax cutter. Warrior. Now healer-in-chief.

That’s the theme the Bush White House intends to sell to a politically divided public in the coming presidential election year.

Tuesday’s final congressional passage of landmark Medicare prescription-drug legislation permits President Bush to fulfill a campaign promise, reaffirm his claim to be a compassionate conservative and abscond with an issue that had belonged to Democrats for decades.

“Good policy makes good politics, and this is good policy,” said Ken Mehlman, the director of the Bush-Cheney “04 re-election campaign.

“It’s huge,” Republican pollster Whit Ayres said. “It was a Republican president and a Republican Congress that produced it. And they produced a benefit on a normally Democratic issue that speaks to the group of people who are most likely to turn out in an election.”

But by stepping off the flight deck and into the pharmacy, Bush is entering risky territory. Some conservatives have deep misgivings that the bill will create an expensive new federal entitlement, and Democrats want to capitalize on seniors’ fears that the plan’s expansion of private-sector competition will undercut traditional Medicare.

While Bush and other Republicans can count on the powerful AARP seniors’ lobby as an ally on this legislation, some seniors are militantly opposed and have been burning, cutting and discarding their AARP membership cards in protest.

Because the main drug benefit won’t take effect until 2006, the ultimate political winner will be the party that best defines the sweeping new law in the public mind. Both sides tested their lines during debates in the House of Representatives and the Senate, but Bush holds the biggest megaphone.

“Some said Medicare reform could never be done. For the sake of America’s seniors, we’ve gotten something done,” he told about 150 seniors and health-care workers at the Spring Valley Hospital Medical Center in Las Vegas.

For Bush, projecting the image of a domestic-policy president may be success enough. But the long phase-in for the controversial changes also could protect him from any backlash if the legislation fails expectations. It also permits him to boast about the drug benefit before it meets a reality test.

Democrats say the two-year wait for benefits might surprise and anger seniors who expect prompt access to drug coverage. It also permits Democrats to attack the benefit as deficient before seniors can judge the coverage for themselves.

On the campaign trail Tuesday, former Vermont Gov. Howard Dean, the front-runner for the Democratic presidential nomination, said the bill “will pay for less than a quarter of our seniors’ prescription drug costs” and that it “guarantees drug prices stay high.”

Sen. Joseph Lieberman of Connecticut, another Democratic contender, accused Bush of “trying to gut Medicare as the price for giving seniors the medicine they’ve needed for years.” Sen. John Kerry of Massachusetts, also a candidate, said the Bush-backed bill would deny seniors a “quality Medicare plan that allows them to choose their own doctors and their own hospitals.”

But the Democrats’ attack is diffuse, and some strategists say they need to come up with a more focused message to beat the advantage Bush just gained.

“We have to sharpen it, narrow it,” said Sen. Jon Corzine, D-N.J., the chairman of the Democratic Party’s senatorial campaign arm. “You can start with the fact that for the first $5,000 of drug payments, you’re going to have to pay $4,000 to get that marginal $1,000.”

It’s a compelling argument. The way the benefit works, seniors with $5,000 in drug costs would have to pay $3,920 in deductibles, cost-sharing and premiums.

But it’s no more compelling than Bush’s.

At the Las Vegas rally, he explained how Medicare now will pay for a $28,000 hospital stay for ulcer surgery. But before this bill, he said, Medicare would not “pay the $500 for the anti-ulcer drugs that would keep the senior out of the hospital in the first place.” Now Medicare will pay that up-front cost. “It doesn’t make any sense to pay $28,000 at the end of the process, but not the $500 up front to keep the $28,000 from happening in the first place.”


Centrist Democrats maintain that Bush is more vulnerable if they point to the new benefit’s whopping cost to the Treasury – nearly $400 billion over 10 years – and the impact on already-record budget deficits.

“This intensifies our already stark fiscal problems,” said Will Marshall, the president of the Progressive Policy Institute, a research center for pro-business Democrats. “What we’ve got here is a new benefit without substantial reform. It adds on to the growing Bush deficits.”

Bush gets similar flak from his right flank. Conservative thinkers and politicians denounce the bill as an abdication of traditional Republican principles. Their attacks could create a right-left tempest that galvanizes seniors.

“There are some conservatives who simply don’t want the government providing health care,” said Ayres, the Republican pollster. “But we lost that argument in 1965. Refighting an almost 40-year-old fight doesn’t offer a lot of political benefit.”



(c) 2003, Knight Ridder/Tribune Information Services.

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ARCHIVE PHOTOS on KRT Direct (from KRT Photo Service, 202-383-6099): medicare

PHOTOS (from KRT Photo Service, 202-383-6099): medicare

AP-NY-11-25-03 1910EST



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