Editorial from the Post
Medicare Impasse
Sunday, October 26, 2003; Page B06
TO UNDERSTAND JUST WHY it has been so difficult for Congress to come up with a bill to reform Medicare, look no further than two letters that members of Congress have written in recent weeks. One was signed Thursday by 39 Senate Democrats as well as Sen. Olympia Snowe (R-Maine) and Sen. Jim Jeffords (I-Vt.) -- enough senators, in other words, to stage a successful filibuster. The letter objects, in particular, to a plan to allow seniors to choose between traditional Medicare and private Medicare plans offered by insurance companies. Sen. Thomas A. Daschle (D-S.D.), the minority leader, denounced this idea as the "privatization" of Medicare, while Sen. Debbie Stabenow (D-Mich.) said it "does away with Medicare" altogether.
The other letter was sent in September, and it came from a group of 13 conservative House Republicans, later joined by more, whose votes are no less crucial to the passage of a final bill. All had voted for the Medicare bill in June, when it passed by a single vote. All declared that if the traditional Medicare plans were not going to be competing directly with private health plans, as envisioned in the original House bill, they would not support the final legislation. Not only do they directly oppose the Senate Democrats, in other words, they too have the power to stop the bill from passing.
Other differences exist between House Republicans and Senate Democrats. The former insist that there must not be price controls on the drug industry. The latter, in the words of Mr. Daschle, insist that issues of price controls "have to be addressed in the bill." House Republicans also want the bill to include language stating that $400 billion is the outer limit of what Medicare can spend on prescription drugs. Senate Democrats have made it clear that they find this unacceptable. In Mr. Daschle's words, "we also think that putting caps on Medicare spending eliminates the very character of Medicare itself as an entitlement program."
These differences are not minor, narrow or easily resolved: They represent fundamentally different understandings of what this bill is supposed to be about -- whether it is merely an expansion of Medicare to include prescription drugs or a much deeper reform of Medicare, aimed, among other things, at making the program cost less over time. In the original House and Senate bills, this deep difference was papered over by a compromise that gave one faction a cheaper, and much less satisfactory, drug benefit in exchange for shallower, and probably more ineffective, reforms. Now, it appears, that compromise has come unglued, which is hardly surprising.
From the time these bills were first discussed, we have argued that there is no point in passing another major piece of Medicare legislation that does not halt the growth in the program's costs: This one does not. We have also argued that Medicare must change to reflect the health care revolution of the past four decades: This one does not do that either. During the course of the conference debate about Medicare, negotiators have discussed some ideas that do have the potential to address Medicare's deeper problems -- such as a plan to means test at least a part of the program and ask wealthier seniors to pay slightly more for their care. Others have proposed much simpler, and more easily controlled, forms of drug benefit that would go only to low-income seniors who have no other coverage. This is the direction the debate should be headed, if Congress's Medicare reformers are serious about compromise and about their original plan to use the "carrot" of a new benefit in order to implement the "stick" of reforms.
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