Medicare Reform Debate to Highlight ‘Classic’ Differences

Given the "inherent difficulty" in overhauling Medicare, the New York Times examines the National Bipartisan Commission of the Future of Medicare, a task force that "expir[ed] in deadlock in March 1999," and how ideology and politics will make it difficult for President Bush to press proposals to make Medicare "more like ... private health care." Formed under the 1997 Balanced Budget Act, the commission was tasked with answering "long range" questions about Medicare's solvency in anticipation of the "onslaught" of 77 million baby boomers beginning in 2010. The commission's basic proposal, one that is supported by many Republicans, including President Bush, was to restructure Medicare to provide beneficiaries with a "fixed amount" each year, which they could use to purchase coverage from "an array of competing private health plans" or traditional Medicare. However, the Clinton administration blocked the proposal, since it did not "shore up" Medicare financing or add a drug benefit to the program. But even before Clinton "assailed" the plan, opposition to the plan was "intense on the commission itself," as congressional Democrats viewed the proposal as a "backdoor effort" to privatize Medicare." One expert said the commission "became the classic division between the market people and the traditional Medicare people."

The "same divisions" that prevented the commission from successfully pushing its proposals now may "doom" any new attempt at reform. New attempts to change the Medicare system will be "enmeshed" in a "fight" over the use of projected budget surpluses, Bush's proposed $1.6 trillion tax cut and prescription drug benefits, as the Times reports that Democrats "like "nothing better than presenting themselves as the 'guardians of Medicare'" against Republicans "bent on using the surplus for 'tax cuts for the rich.'" But given that Bush "explicitly and repeatedly" pledged during his campaign to convert Medicare to a more privatized system and the fact that the GOP congressional leadership supports such a plan, many "prominent" Republicans say changing the program may be easier this time around. In addition, the Times reports that with an "immense political pressure" to add some type of drug benefit for Medicare, structural changes to the program may be pushed through. Sen. Bill Frist (R-Tenn.) who was a member of the commission, said, "The thing that's changed, and why what's happening today is totally different, and we can predict success, is twofold -- presidential leadership that has made this a priority, and secondly, the driving force is prescription drugs."

While the GOP sees a "consensus" on enacting reform, the Times reports that Democrats are more "grim" about the looming debate. Congressional Democrats continue to oppose proposals to privatize the program, comparing the plan to school vouchers. John Dingell (D-Mich.), who sat on the commission, said the privatization efforts similar to those backed by the commission would "throw millions of elderly Americans onto the tender mercies of the HMOs.'" Despite such concerns, Rep. Bill Thomas (R-Calif.), who chairs the House Ways and Means Committee, said there is a "clear consensus" for allowing more competition in Medicare. "It's a question of how you get there. And how you get there is a matter of priority and commitment and will," he said. But Bruce Vladeck, who once ran the Medicare program, said any agreement may not be popular with the public, noting, "There's a consensus among the policy elite, the think tank folks, the academics, but if you tried these ideas with the public they'd think you were insane. If you listen to beneficiaries, it's not 'choice' they're asking for -- they want additional benefits" (Toner, New York Times, 2/11).