Medicare proposal does not consider long-term effects
T he congressional debate over Medicare — mainly
centered on whether to add a prescription drug
benefit to the health-care program for older Americans, although other issues are in play — almost looks like an inversion of the conventional wisdom. Republicans, including former House speaker and general gadfly Newt Gingrich, are pressing to add a hefty new entitlement to an existing government social program. Democrats are threatening to filibuster. What’s going on?
Weren’t Republicans supposed to be the ones who opposed most new government programs and occasionally even murmured soothing words about reducing the size and cost of government? Aren’t Democrats generally in favor of more programs, especially those that involve spending tax money on identifiable constituencies?
As happens so often in Washington, the tussle begins to make sense when viewed from the perspective of short-range political opportunism rather than long-term ideological objectives or commitments.
Republicans in Congress may still offer occasional rhetorical obeisance to the idea of smaller government, but when a Republican is in the White House they generally go along with what the president wants. And when an election is close, presidents of both parties tend to go shopping for votes with the taxpayers’ money.
The political operatives have convinced the president and/or his advisers that conferring what can be spun as an additional benefit on older Americans will stand him in good stead at the ballot box next November. Some Republicans in Congress who still have some residual loyalty to conservative principle tried to tack on a modest bit of reform to the program. Democrats, wedded to the program as it is, smelled out the ruse and decided they would rather try to block it — and with any luck hand the president a legislative defeat they can use to their advantage next November.
The reform that conservatives tried to sneak in is based roughly on the Federal Employee Health Benefit Plan; it would give seniors a fixed monetary benefit (please don’t call it a “voucher”!) which they could use to obtain traditional Medicare or a competing private plan (prescreened, of course). If they chose a more expensive private plan they would pay the difference, and if they chose a cheaper plan they would realize part of the savings. The idea was that competition, as it usually does, could drive down premium prices over time.
The Republicans found they didn’t have enough votes to get this modest reform approved. Some Democrats (not all) really want what is usually called a “single-payer” plan, which is the politically correct way to describe a national health system modeled after Canada’s, so they oppose any reform that gives private companies a larger role in the Medicare program. So the Republicans compromised and accepted a “pilot program” in six cities.
As Robert Moffit, director of health care policy studies at the conservative Heritage Foundation, said, however, “There’s no reason to test this concept. It’s worked for federal employees for decades.”
So conservatives are getting considerably less than half a loaf from this legislation in return for accepting an open-ended entitlement at a time of rising federal budget deficits.
If this proposal passes, we will yet again have policy built around short-term political calculation rather than sound policy analysis. And you can bet that it will cost more than the current estimate of $400 billion over 10 years.
Congressional leaders hope to get the bill through both the House and Senate before Thanksgiving. We hope Congress contains enough conservatives with sufficient principle to buck the White House and join the Democrats in defeating this bill. The Medicare system is an expensive mess that could use some fixing. But it won’t get better by purposely making it worse first.