New York Times Examines Campaign Battle Over Dean’s Medicare Record

The New York Times on Wednesday examines the "difficulty" faced by Democratic presidential candidate and former Vermont Gov. Howard Dean (D) for his stance on Medicare spending in the mid-1990s. Some Democratic party members, including presidential candidates Rep. Dick Gephardt (Mo.) and Sen. John Kerry (Mass.), have said that the stance shows that Dean did not side with the party during a time when lawmakers were considering not only reducing Medicare spending but also restructuring the program. According to news reports, Dean in 1995 said he was "fully subscribed" to reducing Medicare spending growth, and he reportedly "praised" a portion of a Republican-supported budget plan to do that, the Times reports. The plan, advanced by Sen. Pete Domenici (R-N.M.), would have reduced the Medicare spending growth rate by about $260 billion over seven years. According to a Dean spokesperson, Dean supported the provision's "general goal on Medicare spending" (Toner, New York Times, 10/1). Gephardt voted against that bill, and former President Clinton vetoed it. Dean has said a budget resolution signed by Clinton in 1997 backed Dean's position of reducing Medicare spending. Gephardt has said that measure included a Medicare spending reduction of $115 billion over five years. Gephardt did not vote for that measure, either (California Healthline, 9/29).

Critics also have said that Dean told the Associated Press in 1993 that Medicare is "one of the worst things that ever happened" and a "bureaucratic disaster," according to the Times. An unnamed veteran Democratic staff member said that during the mid-1990s, any Democrat who disagreed with the party and agreed with Republicans' spending goals was considered "extremely unhelpful." Gephardt and Kerry during a Democratic presidential debate Thursday said that Dean sided with former House Speaker Newt Gingrich (R-Ga.) on Medicare. Dean responded during the debate that the allegation is "flat-out false." On CBS' "Face the Nation," Dean said, "The person I supported was Bill Clinton. Bill Clinton signed a bill that was very much like what I was proposing." Dean allies have said that the former governor's views on Medicare were similar to those among Democratic deficit hawks and Democrats who were concerned about the financial future of both Medicare and Social Security. Former Sen. Howard Metzenbaum (D-Ohio) said, "Eight years ago, when Howard Dean saw Medicare spinning out of control and facing bankruptcy, he joined with the Clinton administration and key members of Congress in calling for cost controls."

But "several veterans of the budget wars of the mid-1990s" have pointed out "major differences" between the 1995 measure and the one that ultimately became law in 1997, the Times reports. Chris Jennings, health care adviser for Clinton, said, "Dean is right that the Clinton administration desired to constrain growth in the Medicare program and strengthen the trust fund. But we did not embrace the magnitude of cuts advocated by the Republican leadership." Robert Reischauer, former head of the Congressional Budget Office and now president of the Urban Institute, said that at the time "[t]here was a pretty broad consensus that Medicare spending would have to be slowed down," but he added that the 1995 Republican plan "was too much and ... in the wrong form." Bruce Vladeck, former head of CMS, then known as HCFA, said that Dean's stance "sounded to me like the complaints of a general practitioner, who really didn't know what he was talking about." Vladeck added, "But [Dean] did run a good Medicaid program" as governor of Vermont. Dean now supports a Medicare prescription drug benefit and has not advocated any program spending reduction, according to the Times (New York Times, 10/1).