Two local activists stood in front of a crowd of about 30 people Monday at the William Guy Federal Building in Bismarck, urging them not to support a bill that would create a Medicare prescription coverage plan.

The bill fails to address the rising costs of prescription drugs and takes a step toward privatizing Medicare, protesters said. Without containment of prescription drug prices, Medicare recipients fear the proposed premium, copayment and deductible would rise with drug prices.

"This addresses coverage but the mechanism is so flawed," said David Kemnitz, president of the North Dakota AFL-CIO, who was one of the speakers. "Drug costs are skyrocketing and in addressing the problem this way many will be left short of coverage with privatization. In the end there are so many inequities and gaps that it doesn't address."

There are two versions of the Medicare bill before the House and Senate, which will be debated this week. Both versions add $400 billion over the next 10 years for prescription drug benefits - which currently aren't included in Medicare - to the program. Under the proposal, Medicare recipients could chose whether they wanted coverage and if they elected to have the benefit, they would pay a $275 deductible, after which recipients would have a 50 percent co-pay. The premium would be $35 a month.

Sen. Kent Conrad, D-N.D., and Sen. Bryon Dorgan, D-N.D., both support the concept of the plan but agreed it's inadequate as it stands. They said they will be working with other lawmakers this week to improve the plan. Conrad said although the plan has flaws, it is better than what Medicare recipients currently have - no coverage.

"This is a substantial expansion," Conrad said. "It's important to understand what this is and what it is not. It is a basic prescription benefit. There isn't the money to have what most of us consider to be a substantial drug benefit. It's better than nothing."

Dr. Vinod Seth, a speaker at the rally, said the plan would cause almost half of Medicare recipients who use less than $1,090 in prescription drugs per year to lose money because they would be paying more in for coverage they weren't using. He said although the plan is optional, it penalizes people every year they don't elect for coverage.

"If at 70 your doctor tells you that you have high blood pressure, heart disease and cholesterol and you decide to buy the premium, they will penalize you for the 10 years you were not in the program," Seth said.

One of the concerns protesters voiced was the plan's potential affect of employers dropping their retirement health coverage plans because retirees would have the Medicare option. It is estimated that possibly 37 percent of employers would drop their benefits for retired employees to save money.

Conrad said there are several amendments to address this problem which change the definition of out of pocket expenses to include the coverage that employers already provide.

"Those amendments are strongly favored," Conrad said. "It is a serious concern."

Another flaw in the proposed plan is a lack of provisions to contain the cost of prescription drugs. The only thing included in the plan is an amendment added by Dorgan that legalizes the reimportation of Food and Drug Administration approved prescription drugs into the country by pharmacists and distributors. With lower costs in Canada, savings will be able to be passed onto United States' residents.

"Part of the thought was that this would provide leverage," Conrad said. "It compels the pharmaceutical manufacturers to sell at lower prices."

While reimportation has been included, both representatives and citizens agree it doesn't address the problem sufficiently, especially since the United States carries the highest price of prescription drugs.

"There is no sense in going to a physician if you can't buy what is prescribed," said Dr. Herman Wilson, a retired physician who attended the rally. "This (the proposed plan) affects my sense of fairness and feeling that we are the richest country in the world and we can't help out our poorer citizens as well as other industrialized countries."

A common term used throughout the protest was privatization and the fear of the plan forcing Medicare recipients into HMOs.

While Dorgan and Conrad said the President Bush's proposal initially supported privatization, it has been excluded from the Senate version of the bill. Protesters said no matter what the senators say, it will be privatized.

"The whole bill is a drug plan that is run by private insurance companies," Seth said. "People will have to pay a premium but that is only a suggested premium. Since when has the private sector listened to the government on how much they can charge for the premium. Both the premium and deductible will go up with drug inflation."

Both versions of the bill are being heard this week and worked on by members of Congress.

(Reach reporter Sheena Dooley at 250-8225 or sheenadooley@ndonline.com.)