Even in Washington, the spectacle has been hard to ignore. For weeks, the capital's most powerful lobbyists have been working overtime to stop a proposal that would bring drug benefits to Medicare recipients.
And for weeks, the country's senior citizens have fought for the provision with all their might.
"Here is a new entitlement program that could restrict patients rights," said Jeffrey Warren, a spokesman for the American Pharmaceutical Manufacturers Association. "It could lead to a chilling of the freedom of choice and a cut in the quality of care. It will discourage investment needed for future drug breakthroughs."
The American Association of Retired People (AARP), and other groups that represent the elderly, have another view.
"If fairness matters at all," said Peggy Hannan of the AARP, "I don't see how you could possibly oppose it."
But drug companies are not happy about Rep. Henry A. Waxman's (D-Calif.) proposal for Medicare to pick up the costs of prescription drugs for those who now spend more than $400 a year on them. They say that the added premiums will devastate senior citizens, that numbers supplied by the Congressional Budget Office are fuzzy, and that federal regulation would cut innovation without controlling costs.
"They have been over us like a swarm of locusts," said a staff member of the House Energy and Commerce Committee, which will consider the amendment to catastrophic health care legislation today. "The idea of the federal government instituting a drug benefit makes them crazy."
Although the large drug companies declined to discuss their opposition to Waxman's proposal on the record, they have hired some of the District's top lobbyists to defeat it. J.D. Williams, Thomas Boggs and Joseph Dowley have been reported to be on the Hill, speaking against the amendment.
According to CBO figures, of the country's 30 million Medicare beneficiaries almost 5 million spend more than $400 each year on prescription drugs. The average annual cost for that group is $927.
The drug provision would be financed by raising Medicare premiums. The CBO said it would add $4 a month per person. Drug manufacturers say it would cost much more, perhaps an additional $20 a month.
The amendment would include drugs among catastrophic illness insurance benefits. Prescription drug prices have risen more than four times the inflation rate in the past two years, according to a recent congressional study. The AARP said that many senior citizens do not purchase needed drugs because they cannot afford them.
"We absolutely believe that older Americans should recieve the medicine they need," Warren said. "But people are rushing into this legislation with no real idea what it costs. Why not find out?"
The Democratic leadership has endorsed the proposal and worked hard for its adoption. But House Republicans, led by Rep. Edward R. Madigan (R-Ill.), have sought to require state Medicaid programs to offer drug benefits to people over age 65 who make up to about $10,000 each year. They say this will target the needy without establishing a new program that could cost far more than current estimates suggest.
"I think it delightful to see the drug companies and my Republican colleagues lining up behind a Medicaid plan for the first time," said Waxman. "When we introduced Medicaid bills earlier in the year we never heard a word from them. This is just a ruse, a way to divert attention from their real plan."
But industry lobbyists argue that the program could cost up to $7 billion within a year, and they worry about future cost controls and other regulations they claim would hurt the drug companies -- and the people they serve.
Privately, they are fearful that federal control of a prescription drug program could usher in tough cost constraints and restrictions on the variety of drugs the government will pay for.
The amendment would require that the federal government pay the lowest amount for prescription drugs. That would mean that when generic replacements could be substituted for brand name drugs, the government would not pay the higher price.
"This is their worst nightmare," one public interest lobbyist said. "They will fight it to the death."
More than 75 percent of Americans over age 65 use prescription drugs, according to an AARP study in 1986. Among the chronically ill, that figure is 90 percent. For the elderly just above the poverty level -- a couple earning $10,000, for example -- and paying $1,000 each year on drugs, the costs can be significant.
"What is really striking here is that this will open huge new markets for these companies," said Rep. Ron Wyden (D-Ore.), an amendment supporter. "The day this bill passes, it will suddenly be possible for senior citizens to pay for drugs they cannot now afford. How can that be bad for business?"