November 30, 2003 - I look for the President to be on the road next week looking for another photo-op. He will be looking for a room full of older Americans to gaze adoringly while he signs the Medicare Reform Act of 2003 with a dozen or so pens. One problem he has is his relatively short name. There just aren't enough letters in it to accommodate the need to have a sufficient number of souvenir pens to give out. I will predict that it won't take place in South Florida . The older Americans living there may have difficulty reading restaurant menus or punchcard ballots but they have been around long enough to recognize a Medicine Show when they see it.

South Floridian retirees interviewed by Robert Pear for an article published in the November 30 th New York Times don't see the trumpeted prescription drug program doing much to help fixed income seniors with the cost of their life sustaining medications. One thing Florida retirees do well is the math of surviving. They have put pencil to paper and figured out that they can save more by taking a trip to Mexico or Canada than relying on Medicare to cut their drug costs. When the drug manufactures and pharmacies were successful in getting a ban on the government negotiating for lower prices included in the bill, they figure that the Republicans and AARP simply sold them out.

Inner-city hospitals got sold out too. The bill is supposed to increase the payment for hospitals and doctors but the formula is skewed to send the bulk of the money to rural hospitals whose labor costs are the lowest. With its wide open spaces, those miles and miles of miles and miles, Texas will reap the greatest harvest of new Medicare dollars.

Perhaps the biggest dose of Medicine Show Snake Oil comes with the promise of more Federal funds to pay hospitals for care provided under Medicaid - the program that pays for care provided to the poorest of Americans. The problem is that those increased funds are tied to an increase in State spending for the Medicaid program. With the crunch in State budgets brought on by the Bush economic plan most States from New York to California are looking for reductions in their Medicaid budgets. Not even the Terminator has figured that one out.

Maybe he can do a fund-raiser in Indianapolis and sign the bill in front of a crowd of retired Eli Lilly executives. He could even recycle the Mission Accomplished backdrop!