ROANOKE TIMES
Copyright (c) 1995, Roanoke Times
DATE: Sunday, December 3, 1995 TAG: 9512050003
SECTION: EDITORIAL PAGE: F-2 EDITION: METRO
AS THEIR ticket to political fortune, President Clinton and fellow Democrats have seized on scaring people about Medicare.
The GOP leadership, for its part, claims its proposed cuts in projected Medicare funding have nothing whatsoever to do with the other congressional goals of balancing the budget and delivering tax breaks. The Medicare cuts, say Republicans, are needed solely to save the system.
It's all a crock.
What we're witnessing, and suffering, is not a serious debate about Medicare but a cynical exercise in jockeying for public-opinion points.
Republicans at least are being honest in pointing out that Medicare's current $178 billion cost will grow at an unsustainable pace unless changes are made. The GOP deserves credit for proposing cuts in a popular program.
Unfortunately, the huge extent of the proposed austerity seems driven less by concern for Medicare's sustainability than by the need to compensate for tax-cutting.
The GOP cost-containment plan makes up in toughness what it lacks in imagination. The Congressional Budget Office says 70 percent of its savings would come from lowering what the government pays to health-care providers and insurers - in other words, price controls that are likely to decrease accessibility (by driving good doctors out of Medicare, for one thing) while increasing bureaucratic regulation.
While the GOP would offer consumers a choice between Medicare and private insurance plans, it would forbid insurers from charging more than what the government pays for Medicare.
Meanwhile, by merely mobilizing senior-citizen resistance and offering smaller savings - primarily by cutting payments to providers - the Democrats are obstructing reform of a system destined to explode. If their scare tactics prove politically successful, chances of enacting needed structural changes in entitlements will shrink sharply.
In searching for a better way, one proposal deserves more attention than it has received. The Progressive Policy Institute, an offshoot of a group of moderates called the Democratic Leadership Council, recommends lowering costs by encouraging more competition among private health plans.
Private plans would bid on a benchmark package of benefits. Medicare beneficiaries would get a government subsidy based on the average bid, and buy a private plan. Consumers would be able to join private, regional consumer purchasing cooperatives, chartered by the government, which would monitor the quality of the health-care plans and negotiate the best cost and benefit deal.
Two key - if politically risky - elements would be means-testing the Medicare subsidy, and delaying the age at which Americans would be eligible for it. Both are essential if the nation is to move toward a rational health-care-delivery system that offers universal coverage. Taxing uninsured workers to pay for health-care coverage for affluent retirees is insane.
The goal of the institute's plan would be to have Medicare and Medicaid beneficiaries and private employers and purchasers all linked to regional, privately operated information networks that would combine collective purchasing power with freedom of choice and market-based pricing.
Whether this plan or another makes sense, the larger point is for Congress and the White House to think about Medicare in the context of not just spending cuts but health-care reform, and not just partisan advantage but public good.
LENGTH: Medium: 64 linesby CNB