It's one of the maxims of Washington: The tough problems are
addressed last, while the easier ones seem to get all the attention.
That's the way it's shaping up with reforming Medicare, the
problem child of America's entitlement programs for senior citizens.
Next to its big brother, Social Security, Medicare is simply too
difficult to handle - even though analysts agree it's the more
The Medicare trust fund, for instance, is expected to go bankrupt
around 2012. Social Security, on the other hand, still has decades
left, and isn't expected to reach insolvency until 2032.
But Medicare is far tougher to fix than the federally funded
retirement program, and that's why President Clinton is revving up
the political engines to "save Social Security first."
This doesn't mean Mr. Clinton has no plans for Medicare. He's
asking Congress to set aside 15 percent of projected budget
to gas up the trust fund that serves 39 million Americans. He says
this would extend the life of Medicare to 2020.
But as a senior aide to the president admits, "it's a real long
shot for anything to happen on Medicare this year, other than
securing some of the surplus." The problem with Medicare reforms,
the aide explains, "is they are more ambitious, complicated, and
immediate than the Social Security reforms."
For one thing, the government's medical assistance for the elderly
has a double burden to bear: increased medical costs combined with a
growing number of older Americans. Social Security only has the
demographic surge to consider.
While the overall choices for the two programs are the same
(increase taxes, cut benefits, or change the system), it's the
complexity of the Medicare system that almost repulses reformers.
Consider, for instance, the 111,000 pages of rules and regulations
for Medicare and the pricing for 7,000 different medical procedures.
THAT complexity, says Deborah Steelman, a Republican member of the
government's bipartisan commission to reform Medicare, is one of the
reasons that "no one likes to report on it, write about it, or talk
But that is the task of the commission and its 17 members, who
were appointed by Clinton and congressional leaders. They are set to
issue a report advising Congress and the White House on March 1.
According to Ms. Steelman, about 10 of the members can broadly
support a plan by commission chairman John Breaux, a Democratic
senator from Louisiana, to have Medicare subsidize health-insurance
premiums instead of its current fee-per-service system.
Under this set-up, Medicare would pay seniors a benefit to buy
insurance they would select from a menu of options. Beneficiaries
could expand their coverage by paying additional premiums. …