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Spokane, Washington  Est. May 19, 1883

Opinion

Smart bombs

Gary Crooks The Spokesman-Review

The Bush administration has devised a “new way forward” in Iraq. Congressional Democrats have hatched a plan to bring down prescription drug prices for those enrolled in Medicare Part D. Both forays will fail because they lack the one big weapon that savvy car buyers always tote with them: the willingness to walk away.

President Bush is clearly putting pressure on Iraqi Prime Minister Nouri al-Maliki to take the lead in quelling the violence. As the president said in Wednesday’s speech, it will be Iraqi forces “conducting patrols, setting up checkpoints, and going door-to-door to gain the trust of Baghdad residents.”

U.S. Rep. Cathy McMorris, R-Wash., picked up on this theme, saying, “The Iraqis need to take action to prove their commitment to securing and governing their own country.”

And if they don’t? The president was silent on the consequences.

As Slate’s military writer Fred Kaplan notes, “When the United States threw several thousand troops into Baghdad this past fall, Prime Minister Nouri al-Maliki promised to contribute six Iraqi battalions. … Only two battalions showed up.”

The war’s supporters have long said that timetables serve only to tell terrorists and insurgents how long they need to hold out. But the absence of consequences signals to Iraqi leaders that our demands need not be met. They’re like car dealers who know we really, really want that car and won’t leave without it. That unwillingness to walk away translates into a higher price.

It’s the same with the Democrats’ plan calling for the secretary of Health and Human Services to bargain with drug companies for lower prices. Democrats liken the situation to that at Veterans Affairs, which is able to negotiate deep discounts for veterans. Medicare pays 58 percent more than the VA for the 20 most commonly prescribed drugs for the elderly, according to an analysis in the Washington Post.

The VA accomplishes that by devising a formulary, or list of drugs, that it will cover. This entails saying “no” to certain drugs and walking away from drug companies that refuse to meet the requested price for prescriptions that are covered.

Under current law, Medicare can’t do that, because private insurers run the plans. The HHS secretary isn’t likely to get discounts without leverage. Part D proponents say that’s a good thing, because it gives seniors more choices. But it also gives seniors higher prices. This penchant for giving people everything they want, whether it’s drugs, expensive tests or heroic end-of-life treatments, continually hamstrings efforts to control health care costs.

Democrats can compare Part D with VA coverage all they want, but prices won’t drop until Medicare officials have the authority to walk away.

Can’t have everything. Gee, Mr. Smart Bombs, how would you like it if you were denied a treatment or drug you really felt was vital? Limiting choices is just cold-blooded.”

Limiting choices is the only way to control costs, and it looks downright warm and cuddly compared with the current system, which produces that “doughnut hole” in Part D coverage, ravages government and business budgets and hinders solutions to covering the 45 million Americans who are uninsured.