Chris Satullo: Why the opposition to Rendell's drug plan?

Here's a pop quiz, a toughie.

In Pennsylvania, the legislature is fretting over how to balance the state budget. Meanwhile, Gov. Rendell pushes a pet proposal he says will save about $95 million a year in drug costs for Medicaid, which provides health care to the poor. Legislative Republicans are fighting this notion on the beaches, in the trenches, on the heights.

So here's the question: Given that Republicans love saving money, particularly on programs for the poor, why this opposition?

(a) They sincerely worry it might harm patient care.

(b) The proposal comes from Ed Rendell. GOP leaders cannot bear to support any idea from a guy they can't stand.

(c) As ideological conservatives, they scoff at a notion underlying the proposal: that a government agency can run something more economically than private enterprise.

(d) The proposal, known as the "pharmacy carve-out," is opposed by health insurers and pharmaceutical makers, two sectors that give lavishly to reelection funds.

If you chose (a), that's sweet, really. But you haven't been following Harrisburg very long, have you? The correct answer is a bit of (b), a lot of (c) and a bunch of (d).

The Rendell team wants the state to take over buying prescription drugs for patients in the managed-care Medicaid program.

Here's why: Under federal law, the state can buy name-brand drugs at big, mandated discounts unavailable to managed-care companies. The state does this for thousands of Medicaid recipients in rural areas; it also runs the vast PACE drug benefit for seniors. Eleven other states have saved costs through such a carve-out.

What's not to like? Why this rare spectacle of Republicans howling against a plan to save money on entitlements?

Well, insurers and drug companies don't like the idea, because it could cost them. But they're sharp enough to know they have to make a public-policy case. Here are some of their key claims:

The state is dreaming about the potential savings, because the mandated discounts apply only to pricey name-brand drugs, not cheaper generics. The Department of Public Welfare underestimates the complexity of administering the benefit. And -

big finish -

this plan will get in the way of the cuddly relationship managed-care companies have with patients, which does so much to improve outcomes.

I'll pause for your peals of bitter laughter at that last one.

For argument's sake, let's say Rendell is too optimistic on savings. Heck, let's say by 50 percent. That means the plan would save "only" $50 million a year. As a taxpayer, would you shrug that off?

To explain the hostility, we must look elsewhere. Listen to Steve Miskin, a House GOP spokesman: "They are saying they can actually do it better than private companies. Does anybody truly trust the Department of Public Welfare to efficiently run not only something else, but anything at all?"

There it is: The conservative contempt for government paired with the uncritical worship of corporate genius, which brought you Katrina, the Coalition Provisional Authority, Enron and the predatory lending fiasco.

A little fact for you, Mr. Miskin: In the Keystone State, as around the land, Medicaid's administrative costs (4 to 6 cents per dollar spent) run about half those of the typical managed-care company's.

And, Mr. Miskin, I know Estelle Richman, the accomplished head of DPW, and, I'd trust her judgment over yours, any day, all day long.

Speaking of getting personal, the Rendell administration drafted allies this week to promote its insinuation that the real reason this plan gets little love in the General Assembly, from either side, is the campaign cash (more than $320,000 total) that drug companies have given to the caucuses and key leaders of both parties since 2005.

Like Claude Rains in

Casablanca,

the lawmakers are shocked, shocked, that anyone might think campaign cash from corporations affects their judgment.

Allow them this complaint: For Rendell, the Hoover WindTunnel of campaign finance, to tsk-tsk about their drug company cash - well, it's like Lindsay Lohan lecturing Amy Winehouse on sobriety.

Of course it's not just about the cash. Principles are at stake. The principle that "whatever Fast Eddie wants, we're against." The principle that conservatives must cling to the "corporations always good, government always bad" fallacy, no matter how discredited it becomes.

Unfortunately, another principle gets lost in all the smoke: that the public interest should always trump narrow, private ones.