MEDICARE: Candidates Talk Reform; Experts Doubt Action
As talk of Medicare reform continues to pepper both Vice President Al Gore's and Texas Gov. George W. Bush's campaign speeches, health care experts maintain that the "last decade has shown the immense difficulties in accomplishing such changes," the New York Times reports. The "memory" of recent health care "struggles," such as public backlash against HMOs and the insurance industry in general and President Clinton's "attempt at universal coverage," has infused the current Medicare reform debate. At this point, "partisan mistrust is high" and the "philosophical differences" between Democrats and Republicans "are large and enduring." Democrats are convinced that Republicans will not concede to a "huge, government-run social insurance program," but instead want to privatize Medicare. At the same time, Republicans maintain that Democrats "are less interested" in making policy improvements than they are "scaring elderly voters every election year with dire warnings about what the Republicans will do to Medicare."
Disputing the Details
Also a "matter of intense dispute" are the details of how to modernize Medicare. If elected, Bush's "fast track" approach would direct a new task force to send Congress legislation within nine months of his taking office that would transform Medicare "into an efficient, largely private health care marketplace." Within that marketplace, seniors would receive a fixed amount each year to choose among several health plans, similar to what federal employees now do. However, Bush has been "careful" to say that seniors can remain within traditional fee-for-service Medicare "if they like." Still, according to Bush adviser Dr. Gail Wilensky, the fee-for-service program "would be required to compete" with private plans. Bush's proposal builds upon the work of the bipartisan Medicare commission "that ended in a deadlock" in early 1999. The commission had proposed a plan similar to Bush's, but "broke down" along party lines after failing to secure the 11 votes necessary to make a formal recommendation. Stuart Altman, a commission member appointed by the Clinton administration, said, "The world ought to remember that the bipartisan commission didn't support [the proposal], and the bipartisan support was two Democrats and eight Republicans." Drew Altman, president of the Kaiser Family Foundation, added, "The reason it went nowhere is that it uncovered all the nerves that divide Democrats and Republicans."
A Word from the Gore Camp
The Gore camp also has criticized Bush's proposal, asserting that a government-allotted premium "will never keep up with the costs of the traditional Medicare program." Gore adviser Sarah Bianchi added, "What that would mean is that a lot of beneficiaries would have to go to managed care because they couldn't afford the premiums of traditional fee-for-service Medicare." Gore favors the Clinton administration "modernization" plan advanced last year, but also has focused his campaign on "shoring up the traditional program and adding a prescription drug benefit to it." Like Bush's plan, the Clinton-Gore plan calls for more competition, but limits it to private plans, leaving Medicare out of the picture. Gore also has pushed his Medicare "lock box" plan, which would store away $400 billion in surpluses to be used on Medicare alone. In the meantime, some health advocates predict that Gore will "pick apart Bush's plan," just as he did with former New Jersey Sen. Bill Bradley's proposal (Toner, 9/12).