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Drug Use

The prescription-drug debate has returned to Capitol Hill, and, depressingly, things have picked up pretty much where they left off before the last election. Last week, after House Republicans advanced an unrealistically thin $350 billion plan to subsidize drug costs for the elderly, Democrats pounced. House Democratic Leader Richard Gephardt doubted that "anyone can take Republican claims seriously" and flayed the GOP's "sham bill." In the party's weekly radio address, Michigan Democrat John Dingell mocked the Republicans' "phantom benefit" and compared GOP leaders to shady car dealers. A June memo prepared by the House Democratic Policy Committee proclaimed, "House Republicans are simply trying to mislead the American public."

But Republicans flung the attacks right back, calling the $800 billion House Democratic alternative a reckless, budget-busting fantasy that even the AARP considers unrealistic. Democrats, bemoaned Republican Ways and Means Committee Chairman Bill Thomas, are "cynical enough to wave in front of seniors a program that is solely for a bumper-sticker campaign." Adds GOP pollster David Winston: "The public understands the difference between a real proposal and a pie-in-the- sky proposal."The truth is, everybody's right--and wrong. Republicans want to pass any bill, even one too weak to do much good, to take the issue off the table. Democrats--who want the issue on the table for this fall's elections--don't want to pass any bill at all, which is why they're proposing one that's politically and fiscally unrealistic. "One of the biggest worries that our policy people had was that they'd actually write a good bill," admits a relieved Democratic operative. Now that Democrats can plausibly say they haven't, party leaders believe a prescription-drug stalemate will help overcome their election-year weaknesses on war and terrorism issues, especially since senior citizens make up a huge share of off-year turnout. But that may be wishful thinking. After years of tone deafness on the issue, Republicans have woken up to the potency of prescription drugs. They're still too beholden to the pharmaceutical industry to support the benefit voters want, but they've learned to dissemble skillfully enough to make it seem like they do. Enough so that Democrats hoping that prescription drugs will be their political Viagra may find that it fails them this fall. Nothing gets Democrats more excited about their chances this November than the polling data on prescription drugs. Survey after survey tells them that seniors want Congress to pass a drug benefit soon and that they trust Democrats far more than the GOP to do it. "[It's] the issue on which Democrats have the biggest advantage," declares a June 26 memo from the Democratic polling firm Democracy Corps. Only Social Security comes close.Of course, Democrats felt this way about prescription drugs two years ago, when a drug benefit was supposed to be one of their best mechanisms for winning back the House and the Senate--and for Al Gore to take the presidency. But Republicans, sensing danger, realized they could no longer simply oppose big- spending Democratic proposals; they needed to counter with a plan--any plan--of their own. In the spring of 2000 Republican pollster Glen Bolger memorably instructed his GOP allies, "It is more important to communicate that you have a plan [than] it is to communicate what is in the plan."And they did just that. When the Democratic onslaught came--virtually every major Democratic candidate ran ads touting his or her support for a drug benefit--even Republicans noted for their hostility to new federal entitlements went soft and fuzzy on the issue. Suddenly devout conservatives like Nevada's John Ensign, Montana's Conrad Burns, and Virginia's George Allen all promised to help pass a drug plan. At the same time they attacked the Democratic proposals as big-government boondoggles; George W. Bush even made it sound as though Gore wanted to force seniors into HMOs.A massive advertising blitz by big drug companies made the charges stick. According to The Wall Street Journal, drug companies spent $80 million on the 2000 election--twice the previous record for election-year corporate ad campaigns. In 26 House districts where big pharma ran ads on behalf of vulnerable Republican incumbents, only four lost. Former Kentucky Democratic Representative Scotty Baesler, for one, stopped airing ads on the subject after being relentlessly pounded on the issue, "They did a good job of neutralizing it," Baesler says. "The public was pretty confused about who was going to do what, and they sort of threw up their hands. You kept on trying to explain, but it was just a jumble." A frustrated Gore also de-emphasized prescription drugs late in the campaign and ultimately carried seniors by a mere 51 to 47 margin.Democrats had better luck in Senate campaigns, which are more expensive and thus harder than House races for the drug industry to dominate. Most noteworthy, perhaps, was the narrow victory of Debbie Stabenow, who harped on prescription drugs, over Republican incumbent Spencer Abraham in Michigan. Even in that race, however, during those periods when Abraham outspent Stabenow he was able to turn a slight majority of voters against her plan. "Interviews with voters ... [found] evidence of considerable confusion about the alternative plans," wrote The Washington Post's David Broder in October 2000. "Many voters fell back on their partisan leanings to resolve their doubts." Stabenow's pollster, Celinda Lake, found that on Election Day, 60 percent of Michigan voters said they had a harder time distinguishing the Senate candidates' positions than they had before the race began. "You saw the Republicans really develop the strategy to come back on prescription drugs," Lake said in a post-election press briefing.Unfortunately for Democrats, they are sure to be outspent in this year's midterms, thanks to the GOP's usual fund-raising advantage. Even worse, the drug industry is again dumping huge amounts of cash into congressional campaigns: By the time House Republicans were ready to bring their latest drug plan to a vote this week, the drug industry had largely underwritten nearly $5 million in advertising to defend vulnerable House GOP incumbents in 16 competitive House districts. One such ad, urging Iowa voters to "[t]hank Congressman [Jim] Nussle for fighting to add prescription drugs to Medicare," ran more than 100 times in the first ten days of the month, according to the Journal.Republican pollsters sound confident. In an April PowerPoint presentation to congressional Republicans (those GOP strategy briefings have had a way of leaking lately), the Republican polling firm Public Opinion Strategies reassured GOPers that "[t]he Republican positioning on the prescription-drug issue is a break-even proposition." When the pollsters asked seniors whether they were more likely to agree with Republicans offering a drug benefit "that would cover lower income seniors, those seniors with no drug coverage at all, and any senior facing unusually high drug bills" versus a Democrat plan to cover every senior under Medicare, the respondents split 49 to 48. And that was before most had presumably seen the drug industry's slick ad barrage.Democrats say they're wary of repeating that experience in 2000. "I think we were caught a little flat-footed," says Lake. And with Republicans getting better at masking their intentions, some Democrats worry that one of their most seemingly reliable issues could be in jeopardy. "We're very concerned about it, " says a senior party strategist. "We've been talking about it all week."This year's strategy is to strike harder and earlier at Republicans as pawns of the drug industry--winning free media coverage about the GOP-industry connection--and thus avoid the mind-numbing policy debates that muddied the issue in 2000. "The mistake we make is when we start talking about the donut hole, and the gap in the coverage, and the size of the deductibles--you can't get bogged down in that," says the strategist. "What you really want to drive home is that Republicans are going to put forward a bill that's put forward by the pharmaceutical companies."But not everyone is so hopeful. "The pollsters have always tried to convince Democrats that Social Security and prescription drugs are our twin pillars," says Democratic Representative Cal Dooley of California, who is working on a centrist drug plan he hopes to introduce later this summer. "But you know what? We haven't done very well with older voters. Because the issues become very, very muddled at the end of the day." Just the way Republicans like it.