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Politics : Politics for Pros- moderated -- Ignore unavailable to you. Want to Upgrade?

To: jlallen who wrote (1984)	6/7/2003 11:19:00 PM
From: LindyBill	Respond to of 793890

Bush's Tightrope on Medicare Drugs By RICHARD W. STEVENSON - NEW YORK TIMES WASHINGTON, June 7 - As he prods Congress to complete legislation adding a prescription drug benefit to Medicare on his terms, President Bush has his eye on the opportunity to neutralize a political issue long owned by Democrats, administration officials and strategists in both parties say. But Mr. Bush is also facing the risk that failure at a time when his party controls the House and the Senate as well as the White House would leave Republicans exposed to new attacks that they have left some of the nation's most vulnerable citizens without the means to maintain their health. Mr. Bush's ability to make a deal on Medicare that includes some movement toward the goal of conservatives to harness market forces to hold down health care costs will also be a critical test of his ability to apply the same ideology to Social Security. Adding private investment accounts to the retirement system is likely to be a central plank in Mr. Bush's re-election platform and a big goal of a second term if he wins. After signing his third tax cut into law last month and plunging into Middle East peacemaking this past week, Mr. Bush is now making Medicare his focus. The health care system for retirees was the subject of his weekly radio address today, and he plans to give two speeches on the issue in the coming week, in Chicago and in New Britain, Conn. "The time is right to make progress," Mr. Bush said in his radio address. "Our goal is to give seniors the best, most innovative care. This will require a strong, up-to-date Medicare system that relies on innovation and competition, not bureaucratic rules and regulations." White House officials said they had been encouraged by the emergence of a bipartisan agreement among crucial senators. After starting the year by floating and then disowning a proposal that would have limited prescription drug benefits to retirees who were willing to move from traditional Medicare into managed care programs, administration officials are now signaling that their goal this year is far more modest. They said they simply wanted to establish the principle that encouraging competition among health care providers is vital to reining in the explosive growth of Medicare costs. The administration has argued that a prescription drug benefit can be a carrot to lure patients away from traditional, higher cost Medicare practitioners. "A system based on the free choices of millions of participants can evolve toward sustainability," said Mitchell E. Daniels Jr., who stepped down on Friday as the White House budget director. "A system based on the decisions of a shifting crew of 535 politicians won't." Republicans on Capitol Hill, who have been singed by Democratic attacks over Medicare for years, said they were hopeful that Mr. Bush's involvement could yield a deal this year but were wary of what would happen if the legislation bogged down again. "It's great politics and great policy," said Representative Rob Portman, Republican of Ohio. "At the same time there's a risk that this gets derailed in the process and that we're viewed as having failed to deliver when we have a Republican Congress and a Republican presidency." Polls have consistently shown that voters trust Democrats far more than Republicans on health care. The New York Times/CBS News Poll last month gave the Democrats a 51-to-29 advantage on the question of which party was more likely to improve the health care system. The Medicare issue has also helped Democrats maintain a much smaller but consistent advantage among older voters, especially older women, an advantage that could become more important as the population ages and the proportion of voters who are 65 and older continues to grow. David Winston, a Republican pollster, said the issue had become more pressing for both parties in the last several years because of the bursting of the stock market bubble. The decline in the value of retirement accounts, he said, has left retirees as well as younger people who are planning for their retirement more concerned about their ability to pay for prescription medicines. From age 45 to 54, Mr. Winston said, people are focused on the financial aspects of retirement. From 55 to 64, he said, there is a surge in concern about health care as many such people begin to confront health problems. From 65 on, he said, prescription drug costs become the overriding concern because for many retirees those costs are not only a determinant of their quality of life but in some cases of their ability to survive. "Voters are not looking for an ideologically based solution or a partisan-based solution," Mr. Winston said. "They just want it fixed." Faced with intense pressure from constituents to create a prescription drug program, Republicans in Congress are less keen than the White House to make the new benefit part of a Medicare package that would also contain less desirable elements, like forcing people into managed care or cutting other benefits. As a result, Mr. Bush may not get all he wants in the way of incentives for retirees to move into managed care. But there are signs that he will get something with more immediate political impact: a bipartisan deal in the Senate that could break the legislative logjam. Even more than Mr. Bush's willingness to make a deal with Democrats in 2001 on education ? another issue long identified with Democrats ? his willingness to accept a prescription drug bill that is well short of ideologically pure could have political advantages outweighing any heartburn it would cause among conservatives. "When the Democrats are going to be saying that all we've ever done is cut taxes for the rich, to be able to say we gave Grandma and Grandpa a new prescription drug benefit serves as a powerful counterweight to the Democrats' caricature of the Bush administration," said Bill McInturff, a Republican pollster. Many Democrats continue to oppose the approach taken by the administration and to deride the drug benefit being discussed as entirely inadequate. But other Democrats, especially moderates, appear willing to deal, and there has been no sign that Democratic leaders will filibuster in the Senate in order to keep the issue alive for 2004. "Fighting the next election on new terrain wouldn't be the worst thing to happen to Democrats," said Bruce Reed, president of the Democratic Leadership Council, an advocacy group for moderate Democrats. nytimes.com