Medicare bill marches on

WASHINGTON — The Senate cleared the way Monday for final congressional passage of landmark legislation to add a prescription drug benefit and a free-enterprise flavor to Medicare, repelling twin attacks by die-hard Democratic opponents.

"Today is a historic day and a momentous day," Senate Majority Leader Bill Frist, R-Tenn., said as lawmakers broke through years of gridlock on a bill that would make the most sweeping changes in Medicare since the program was created in 1965.

Defiant in defeat, Sen. Edward Kennedy, D-Mass., said the legislation "starts the unraveling of the Medicare system," and he accused the Republicans of planning a follow-up attack on Social Security after the next election.

A final vote on the bill was set for today, and even opponents conceded the outcome was not in doubt.

At its heart, the legislation was designed as a compromise of sorts, new drug coverage for all Medicare beneficiaries long sought by Democrats, combined with a Republican-backed plan to give private insurance companies a vast new role in health care for the program’s beneficiaries.

The scope of the bill goes far beyond that, though, including an additional $25 billion for rural hospitals and health care providers, a requirement for higher-income seniors to pay more for Medicare Part B coverage and billions of dollars to discourage corporations from eliminating existing coverage for their retirees once the new government program begins.

The bill would satisfy other goals of conservatives, including creation of tax-deferred health savings accounts, open to individuals who purchase high-deductible health insurance policies.

Most controversial of all, the legislation would create a limited program of direct competition between traditional Medicare and private plans, beginning in 2010. Conservatives argue that would help bring down the cost of Medicare over the long run, while critics say it would privatize the program and lead to rising premiums for seniors who remain under the government-designed benefit.

Over and over, supporters of the bill stressed that after years of gridlock, the opportunity to act was at hand.

"If we don’t do this at this time, it may be years" before another opportunity comes along, said Sen. Charles Grassley, R-Iowa, an architect of the bill. "There will never be total agreement," added Sen. Max Baucus, D-Mont., Grassley’s partner for months on the issue.