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Bush Proposes Complex Medicare Drug Benefit

President Bush headed to Michigan Wednesday to promote the elements of his Medicare proposal, which would enable elderly participants to receive prescription drug benefits through a private-public partnership.

"Medicare's been used as a political football," the president said at the Devos Hall Grand Center in Grand Rapids, Mich. "It's old, it's important — but it hasn't changed."

Embarking on the customary habit of taking the State of the Union address on the road, the president also called on Congress to set clear priorities and "not overspend the people's money."

He also committed to engaging in war if Saddam Hussein continues to defy the international community and the United Nations fails to step up to the plate to form a coalition to disarm him.

"Should they not choose to pressure Saddam and should he continue to defy the world ... this country will lead a coalition of other willing nations and we will disarm Saddam Hussein," Bush said. "We will commit the full force and might of the United States military and in the name of peace, we will prevail."

In his address Tuesday night, Bush called on Congress to spend $400 billion over the next 10 years to allow seniors to choose the health care plan with prescription drug coverage that the government can subsidize based on income levels of patients.

On Wednesday, the president said that seniors ought to be able to choose their own health care plans, including a variety of fee-for-service options similar to those offered to members of the U.S. Congress.

"If it's good enough for the Congress it is good enough for the seniors of this nation," Bush said.

Medicare must be made available to seniors in a variety of forms, the president said, but those happy with their current programs should have the benefit of keeping their terms the same.

"If you like the way things are, you shouldn't change. However, Medicare must be more flexible. Medicare must include prescription drugs," the president said without providing many details of how such a system would work.

Prior to the event, White House Press Secretary Ari Fleischer said that the president's speech would not go into details of how the $400 billion would be spent, but said the bulk would go to drug costs rather than provider payments or modernization of the system.

The president's changes would be a major overhaul of the 38-year-old government-provided health care program.

Opponents have already said that the plan will usher seniors into poorly managed insurance programs and even some Republicans have hesitated that a Medicare benefit will get in the way of a comprehensive program.

Bush's plan "will privatize Medicare and hold seniors hostage to HMOs," said Democratic National Committee Chairman Terry McAuliffe.

"He says he wants to help seniors afford prescription drugs, then he proposes a plan to coerce seniors into HMOs to get prescription coverage," said Senate Minority Leader Tom Daschle, D-S.D.

The administration has said that introducing market mechanisms to Medicare, which would work by increasing the reliance on cheaper private health plans to treat the elderly, is the best way to provide costly drug coverage and still be able to pay for a system that could go bankrupt by 2030 because of the aging Baby Boomer population.

"The problem is not Medicare's structure, which works better than any private marketplace structure to ensure universal coverage and access to health care people need. The problem is Medicare needs a prescription drug benefit," said Robert M. Hayes, president of the nonprofit Medicare Rights Center.

The president's plan will give seniors inducements to give up fee-for-service Medicare benefits and enroll in private plans with drug benefits and catastrophic illness coverage. But, it will also allow seniors with traditional Medicare coverage to have their drugs subsidized.

The president also went over several other elements recited in his second State of the Union address, which read like two speeches, one emphasizing domestic issues and the other confronting the threat posed by Iraq.

Standing in front of a backdrop that said "Strengthening Medicare," the president called for a federal medical liability policy to prevent lawsuits from driving doctors out of service.

Bush told the audience to write their congressmen insisting on a liability to prevent lawyers from paying such high premiums that they can no longer practice medicine.

"We want health care to be affordable and accessible to all our citizens, of course, but one problem in our society is that we have too many junk lawsuits ... too many frivolous lawsuits that cause doctors to practice preventive medicine, procedure after procedure," he said.

Bush also promoted his economic stimulus, including dividend tax cuts and an acceleration of the reductions in marginal interest rates expected in 2004 and 2006 and in the marriage penalty tax cut.

"The double taxation of dividends is not fair, it hurts our seniors," Bush said. "For the sake of our economic vitality, Congress must act."

The president repeated the details of his "compassionate" agenda laid out in his State of the Union speech. He said he wanted Congress to provide mentoring and assistance to children who live in challenged environments or whose parents are imprisoned. If the president has his way, the plan, which foresees giving $450 million for such programs, would be administered through faith-based programs.

He also mentioned his request to send billions of dollars in aid to Africa to prevent the spread of HIV/AIDS, a disease that has reached pandemic proportions.

Discussing the dangers to the homeland, Bush said that there is still an enemy that lurks, but the new culture of the intelligence agencies and the creation of a new Homeland Security Department is making critical progress in finding the enemy.

The president received his loudest applause of the day, when he mentioned the firefight in Afghanistan the other day in which 18 Al Qaeda fighters "met the United States military head on ... unfortunately for them."

The White House has been busy finding ties between Iraqi dictator Saddam Hussein and terrorists that would put a nail in Saddam's coffin once and for all. Both in his address Tuesday and at Wednesday's event, the president listed several examples of how Saddam is defying the U.N. Security Council by refusing to give up weapons that he acknowledged that he had after the Persian Gulf War and agreed to surrender. He still has not done so.

But the president made the point that while the international community has sat idly as Saddam continued his defiance, the difference between now and 12 years ago "is that there is a shadowy terrorist network that he can use as a forward army, attacking his worst enemy and never leave a fingerprint behind with deadly, deadly weapons."

"Because of Al Qaeda connections, because of his history, he's a danger to the American people. And we got to deal with him. We've got to deal with him before it is too late," Bush said.

While Secretary of State Colin Powell is heading to the United Nations next week to present more evidence of Saddam's weapons programs and his ties to terrorists, Bush sounded particularly impatient with the international body, which he said he fears will be nothing more than a "debating society."

He said that he got a 15-0 vote demanding Saddam disarm, but that the question now remains when. Bush said that must be done sooner than later.

"The risks of doing nothing, the risks of assuming the best from Saddam Hussein, it's just not a risk worth taking," he said.

The Associated Press contributed to this report.