The NY Times features an article on the political implications of drug costs for the elderly - In an Election Year, These Protesters Have Power. In many ways this will probably become a major 'single issue'.

The Senate deadlock resulted from divisions over costs and levels of coverage, as well as whether such a program should be run by Medicare or the private sector. A poll of 1,071 adults 45 and over, conducted by AARP from July 31 to Aug. 4, immediately after the Senate deadlock, found considerable concern about the issue. More than 60 percent of those surveyed said that prescription drug benefits were a "very important" issue and that they were "angry" or "very angry" that the two parties could not reach an accord.

The same percentage said they were more likely to vote for their senator if he or she supported a prescription drug plan; more than 25 percent said they would vote against their senator if he or she allowed partisan differences to thwart the legislation.

Advocacy groups are marshalling energy over this issue. They are surveying voters and trying to crystallize a position. Financial realities do not matter to those groups, they want their program!

For Mr. Hickey and the groups with which he is aligned, a good bill would set up a price-controlled prescription drug program run by Medicare that covers all drugs for all older Americans and is not "means tested," or linked to income. That is pretty much what most Democrats want. The problem is that it could cost $800 billion or more over 10 years.

Drug companies object to price controls, and most Republicans and some conservative Democrats want a program run by private insurance companies and with limited coverage. That position is best reflected in a Republican bill passed by the House. In that version, there would be coverage for part of drug costs up to $2,000 a year, but then people would be on their own until costs reached $3,700 — a gap that critics call the hole in the doughnut.

The wild card in all this is rising drug costs. Families USA, a consumer advocacy group for health care issues, says the prices of the 50 most prescribed drugs for older adults rose, on average, by nearly three times the rate of inflation last year. The group criticizes big drug makers, saying they pay high executive salaries and spend about twice as much on marketing, advertising and administration as on research and development of drugs.

Jeff Blum, executive director of US Action, an advocacy group, argues that the public is far ahead of elected officials in linking access to drugs with cost control. "People know if there is not some serious controlling of drug prices, they're not going to get the benefit of a prescription drug program," he said.

Of course many would prefer avoiding means testing. The cost of a 'free' program would be very difficult to afford. The pharmaceutical companies will probably lost a battle here on price controls. I wonder if a true compromise will satisfy the activists?