John Rother


Efforts to enact a prescription drug benefit in Medicare date back more than forty years. Since then, drugs have continuously grown in importance; they have also grown in cost. Design and enactment of a Medicare. drug benefit is therefore one of the most challenging health policy tasks before Congress. Many policy trade-offs have to be brokered, powerful interests acknowledged, budget limits respected, and public expectations rewarded. Ideology and partisan considerations also play a prominent role. As the benefit finally nears becoming law, as it inevitably must, the ongoing tension between adequacy and cost-containment has begun to play out in earnest. In all, the Medicare prescription drug debate serves as a microcosm of the competing forces that make the American health care system so challenging to reformers.