The "new bill":www.nytimes.com/2003/11/17/politics/18MEDI-SIDE.html offering a form of prescription drug benefit alongside Medicare benefits is the product of many motivations: to pass a bill called "prescription drug benefit," to provide a benefit that competes with Medicare and makes it impossible for liberal Democrats to support, and to provide a new market for insurance companies.
Given the desperation that both Democrats and Republicans have had for many years to pass some kind of bill, it is amazing how tortured the end result is:
"Beginning in 2006, Medicare beneficiaries could sign up for a stand-alone drug plan or join a private health plan that offers drug coverage. They would be charged premiums averaging $35 a month, or about $420 a year. After the beneficiary pays a $275 deductible, insurance would cover 75 percent of drug costs up to $2,200. After $2,200 in drug costs, the program would pay nothing until the beneficiary has spent a total of $3,600 out of pocket. When out-of-pocket spending reaches $3,600, the beneficiary would pay 5 percent of the cost of each prescription, or a copayment, perhaps $5 or $10 for each prescription. The premium, deductible and coverage gap would be waived for people with incomes up to $12,123 a year. To qualify for the subsidy, recipients could have no more than $6,000 in assets. The subsidies would be phased out between $12,123 and roughly $13,500 in yearly income. The subsidy (not benefit) is designed to compete with Medicare in some markets."
It would seem that neither Republicans (who only know how to solve problems by handing them to large businesses) or Democrats (who resist any kind of means-testing in a benefit program, the accomodation of which might have made the program much less expensive and more generous to beneficiaries) are able to meet a universally-agreed-upon need for some kind of program.
[11/25/2003: Many observers have also noted that since the bill does not work within Medicare and explicitly forbids the government to negotiate for lower drug prices, the actual cost of the bill may be much higher than the estimated $400 billion. This lack of cost containment was one of the reasons for the rebellion of House Republicans against its passage.]