CANCEL your dinner plans. Unplug the phone. Heat up a bag of
popcorn. Even in a year when Congress is considering dozens of
ambitious reforms, nothing will match the upcoming Medicare debate
for raw political theater.
Armed with flow charts, opinion polls, and podium-thumping
speeches, Republicans will portray themselves as the party of good
sense, bent on saving Medicare from insolvency. Democrats will
accuse the GOP of gutting the $180-billion program to finance a tax
break for the wealthy.
The show could start tomorrow, when Republicans plan to unveil
blueprints for slowing Medicare's growth by $270 billion, over the
next seven years. Many observers say this goal cannot be met
without significant cost increases or reductions in coverage.
At stake is the support of the 37 million older and disabled
Americans enrolled in Medicare, and the Republican promise to
balance the federal budget.
But also in question is government itself. Some wonder if Congress
can, or should, be pushed to revolutionize, in a matter of weeks,
a program that consumes 11 cents of every tax dollar.
"This debate will say a lot about the ability of our institutions
to deal with huge programs where there are billions at stake,
millions of people affected, and issues that are exceedingly
complex," says Mark Peterson, a professor of political science at
the University of Pittsburgh. "These are the hardest things for
government to do."
House Republicans recognize the gravity of the task. Win, and they
could become the party of reform for the next generation. Lose, and
they could be drummed out of office faster than their Democratic
Today, House and Senate Republicans are expected to meet privately
to hash out their differences and, as Senate majority leader Bob
Dole put it, begin "singing out of the same hymnal."
By all accounts, Medicare costs are exploding. Since 1970, the
rolls have swelled by 18 million, and Medicare's share of federal
expenditures has nearly quadrupled. Part A of Medicare, which
covers government payments to health-care providers, is funded by a
1.45 percent payroll tax, and is expected to run a deficit by 2002.
Part B, which covers costs like doctor visits and laboratory tests,
is funded by premiums paid by beneficiaries and general tax
revenues. Its costs are also rising.
While the GOP plan is still a work in progress, some details are
emerging. Republicans have avoided raising copayments or
deductibles for beneficiaries - with the possible exception of
those earning more than $75,000 a year. Neither do they plan to
force recipients into managed care networks, or HMOs, that would
limit their choices of health-care outlets.
The GOP plan would achieve $100 billion in savings by reducing the
amount it pays to providers, like doctors and hospitals, to cover
the costs of everything from inflation to new technology and the
treatment of indigent patients. …