A Tuesday article in The Wall Street Journal highlighted the huge difficulties the GOP is having getting political traction from their passage of the Medicare prescription drugs bill. The idea of course was to steal a traditional Democratic issue by providing a new drug benefit for seniors through Medicare. The provision of such an expensive new entitlement, GOP strategists believed, would burnish Bush’s “compassionate conservative” credentials and immunize him against the charge he is only willing to spend money on the rich.

It hasn’t worked out that way. The bill was certainly expensive ($400 billion over 10 years, an estimate the Bush Administration increased to $540 billion after the bill was passed), but not because it was particularly generous. A senior with $5,000 in drug costs will wind up paying about $4,000 of that total bill out-of-pocket. The real reason for the expense was the GOP’s refusal to use the potential bargaining power of the government to hold the prices charged by powerful pharmaceutical companies. In fact, not only did the bill include no cost containment provisions, it actually made it more difficult for US citizens to buy their drugs from Canada, where drug prices are substantially lower.

All this, combined with structural changes to make it easier to move beneficiaries out of traditional Medicare into more restrictive HMOs (health maintenance organizations), has ensured the bill’s stunning lack of popularity, especially among seniors. For example, in an early January Gallup poll, 62 percent of seniors (compared to 53 percent among the population as a whole) said that the new presciption drug benefit did not go far enough. And in a December Gallup poll, seniors, by more than 2:1 (59 percent to 28 percent), thought the new Medicare plan will do more to benefit prescription drug companies than Medicare recipients.

Because of this poor reception, Bush’s approval ratings on health care, Medicare and even prescription drugs for seniors remain abysmal–in the 30's–and have barely budged since the bill passed. And those ratings are uniformly worse among seniors than among the population as a whole. Bush and the Republicans also continue to trail the Democrats by wide margins on questions about who can do a better job handling health care issues. That includes prescription drug benefits for seniors; the cost, availability and coverage of health insurance; and health care generally.

Perhaps the most serious point of vulnerability for the Republicans in this whole area is health care costs. Poll after poll shows that the most serious health care worry for voters is costs and that, in fact, concern about health care costs is either at the top or near the top of voters' economic worries. The general perception is that these costs are out-of-control and are more likely than any other factor to suddenly bankrupt or impoverish a family.

In this regard, the probable nomination of John Kerry by the Democrats deepens the Repubublicans' problems. Not only do they have nothing to say that seems remotely plausible about this problem, Kerry has quite a bit to say and most of it makes pretty good sense. You can read a description of his health care program here, which includes some very interesting cost containment measures.

Kerry, as you can see from the above link, is making a particular effort to target the "worried insured" which, in DR's view, is entirely the right approach. If health care plays a significant role in this election--and it should--it will be because the worried insured break decisively in favor of one of the candidates. Kerry wants to be that candidate.

To some extent, he may already be that candidate. Compared with Edwards, for example, he has talked more about health care and more explicitly targeted insured voters. And in every primary so far, he has done disproportionately well among voters who say their most important issue is health care (for example, 62 percent to 25 percent for Edwards among Virginia health care voters).

It must have seemed such a brilliant stroke to the Republicans when they rammed that Medicare bill through the House. Reality, alas for them, has gotten in the way.