Democratic Rep. Pete Stark of Fremont says until recently he's felt a little like the Maytag repairman.

"Nobody has wanted to talk to us for 12 years," he said. "It's kind of exciting."

Exciting for Stark because if the Democrats re-gain a majority in the House on Nov. 7, as some are predicting, he will chair a powerful subcommittee that oversees Medicare.

And he has big plans to change — or in his words, fix — the year-old Medicare drug benefit, called Part D.

Now with 38 million seniors and disabled enrolled, the Bush administration has touted Part D as a grand success. But Stark sees it as a monumental failure and an insult to aging Baby Boomers and the Greatest Generation.

"You'd think it's been designed for the Iranians or North Koreans, it's so bad," Stark said in an interview.

If — and it's a big if — the Democrats capture 15 or more seats in the House, Stark will chair the Health subcommittee of the powerful Ways and Means Committee, a post he held for nine years before his ouster in 1994.

With that authority, Stark would drive Medicare legislation, including amendments to the 2003 law creating Part D. The drug program launched in January and is expected to cost $724 billion over its first 10 years.

Minority Leader Nancy Pelosi, D-San Francisco, could be Speaker of the House, and she has said changing Part D would be one of her top priorities as well.


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While acknowledging that the Democrats wouldn't likely have enough votes to override a presidential veto, and may not get support in the Senate, Stark said he believes changes to Part D could be made — including creating a government-controlled option to the drug benefit. Today, seniors can choose between dozens of Medicare-sponsored drug plans under Part D. These plans are all operated by private insurers, including Blue Cross, Health Net, UnitedHealthcare.

Stark envisions creating a default drug plan for Medicare beneficiaries that would be run by the federal government, which could negotiate drug prices with pharmaceutical companies, like the Veterans Administration does today.

It's an old idea — one that predates the private-run drug benefit seniors have today under Part D. But Stark says only through a public plan will the government be able to control drug prices seniors pay.

"We have to have a vehicle for the secretary (of the U.S. Health and Human Services Department) to purchase the drugs," Stark said.

Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services, which oversees Part D, said in an interview that market competition is keeping drug prices down.

"I'm not really sure we could do any better than what the (private) plans are doing today," Norwalk said. "Some of these plans are offering generic drugs for free and the VA doesn't even do that well."

Some believe the idea of a public-run drug benefit would gain traction in a Democratic-controlled House, including Robert Hayes, president of the Medicare Rights Center, a nonpartisan advocacy group that has been critical of Part D.

"If the question of allowing Medicare to use its purchasing power were put before the Congress, it would pass overwhelmingly," Hayes said.

And he said it would save seniors money, citing a study by economist Dean Baker of the liberal Center for Economic and Policy Research indicating that government-negotiated drug prices would leave a surplus of $40 million over the next seven years.

Others aren't so sure negotiated drug prices would lower costs.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank, says government controls on drug prices would lead to less pharmaceutical research and development and, over time, only increase health care costs.

And creating a public-run drug plan wouldn't address the core issue of making sure Medicare is solvent for future generations, Cannon said.

"I think it could be harmful more because it would be a distraction from fixing Medicare's real problems," he said. "Stark is just rearranging the deck chairs."

A government-controlled drug benefit would offer some stability to the program at a time when seniors are confused about which private plan is right for them, Hayes said. 

Part D's open enrollment period begins Nov. 15, and beneficiaries are once again being reminded to review a dizzying array of choices. Californians will have 55 stand-alone drug plans plus Medicare Advantage programs to choose from, and many of the premiums and other costs have changed since last year.

"It's something we think would benefit consumers who have been buffeted around by these private plans," Hayes said.

At the very least, Stark said the Health subcommittee could shine a bright light on the health insurers participating in Part D today.

"I think we'll get more information to the seniors," he said, calling some of the insurers "absolute shysters."

Democrats have seized on Part D's shortcomings in races around the country. Rep. Nancy Johnson, R-Conn., who currently chairs the Health subcommittee that Stark would chair were his party to win the House, is in a tight race in her largely Republican district. Her Democratic opponent is running ads highlighting the hundreds of thousands of dollars in campaign donations Johnson has received from pharmaceutical companies in her 12 terms in office.

Despite the campaign talk, substantive changes to Medicare won't happen in the next two years, most analysts agree.

"If we get a divided government this election, we'll get gridlock," Cannon said. "That could be a good thing. In a more polarized environment you're going to get a greater exchange of ideas. The Republicans will be sharpening their knives for '08 and they will need ideas."

Even Stark admits that bigger changes to Medicare won't happen soon.

Stark seemed giddy at the prospect of taking charge again.

"The House has had this free-market, evangelical, self-destructive bent," he said. "I think we'll return to a more moderate Congress. ... I'm the greatest bipartisan legislator you ever saw."