DURHAM, N.C. -- The ongoing Congressional debate over expanding Medicare drug benefits distracts from a more urgent health policy issue: the 44 million Americans without any medical insurance, says a Duke University health policy professor.

"Assuming it is enacted, the Medicare bill once again represents a triumph of politics, illustrating some simple and ugly truths about how health policy is made," says Christopher Conover, an assistant research professor at Duke's Center for Health Policy, Law and Management.

The cost of extending prescription drug benefits to 33 million Medicare eligibles, as currently proposed, could provide typical public medical insurance coverage to 35 million uninsured people or typical private coverage to almost 18 million, Conover says.

"This is all the more remarkable since only 12 million of the recipients of the drug benefits currently have no drug coverage," he adds. "Do the needs of 12 million on Medicare who lack drug benefits outweigh the needs of 35 million who lack any sort of health coverage whatsoever?"

Looked at another way, it has been calculated that the uninsured will experience at least 18,000 avoidable deaths during the current year simply by virtue of their lack of coverage, says Conover, who teaches a class at Duke on health politics in the U.S. Providing medical coverage to 35 million of those uninsured Americans might be expected to reduce this number by at least 14,000.

Conover says the reason for the Congressional focus on extending Medicare drug benefits and not on the medically uninsured can be answered in two words: senior citizens.

"The elderly have three things going for them that the uninsured do not," he says. "First, they vote, early and often -- in both primaries and general elections -- and hence are a force that cannot be ignored by politicians interested in remaining in office. Second, they have in their corner a very powerful lobby, AARP, which constantly advocates on their behalf. Third, virtually all voters and policymakers expect someday to become Medicare recipients, whereas only a fraction might worry about becoming uninsured."

Politics quite often trumps common sense when it comes to policy, especially with the 2004 elections on the horizon, Conover says.

"No one can seriously argue that subsidizing Warren Buffett's prescription drug coverage is a more urgent priority than finding a way to get coverage to 15 million uninsured whose incomes are below poverty, yet that is the path on which we are headed," he says. "But this is merely business as usual."

Conover can be reached for additional comment at (919) 684-8026 or by e-mail.