Principle over Politics? The Domestic Policy of the George H. W. Bush Presidency

By Richard Himelfarb; Rosanna Perotti | Go to book overview

Discussant: Gail R. Wilensky

There are three points that I would like to share with this group. The first has to do with the assessment of the repeal of the Medicare Catastrophic Coverage Act. I, for the most part, agree with comments that Bill Roper just made. I do want to make a small clarification as to my view as to what happened. I do think there was a problem that was being addressed initially, but that the legislation that was ultimately passed went too far. I remember, because I was at a hearing where Representative Stark, who is not normally someone who I had agreed with, made the plea that we should accept the original proposal, perhaps income-relating the financing (which just limited the final-dollar exposure of seniors), and not add additional benefits for drug coverage and nursing homes—not that that wasn’t of interest to him, but that it would kill off a piece of legislation that would be passed.

I think that really is the problem that happened. We took a piece of legislation that was passable and sustainable, and more was added to it than high-income seniors were willing to finance by redistribution of their money to low-income seniors. That, after all, was what it was about. It was clear there was not going to be additional tax monies allocated to the Medicare program. Seniors kept being told that Medicare was a terrific buy. It was, it still is, but after the Medicare Catastrophic Coverage Act was passed it was a less good buy for high-income seniors than it had been before the passage. Whatever else we can say about our active senior population, it is not that you can pull something like that over them without them noticing the change. They protested; sometimes people who were protesting actually would have gained. But it wasn’t that there wasn’t a problem initially being addressed; it’s just that the passage of the bill was in fact too much, and we weren’t honest with seniors about who would ultimately be paying the bill—something that came back to haunt us, at least in part, with the introduction of the Health Security Act: not telling people how it is that you’re going to finance the benefits that you’re proposing.

The second point that I’d like to make has to do with the neglect of a discussion at a session like this about the Bush health care plan, and in its place more focus on the repeal of the Medicare Catastrophic Coverage Act, which happened, after all, very early on in the Bush presidency. And I think it’s a statement that I make with some sadness, because I think that there was a real lost opportunity—a lost opportunity on many grounds. To my mind, the Bush health care plan, for which work started in July and August of 1991; that it was not the last-minute, slap-dash effort that it was sometimes ascribed. I know because, as well as several other people in the room—including, of course, Dr. Sullivan—many of us were working three, four days a week, frequently until 10 o’clock at night and on the weekend, trying to put together what we thought was a detailed and good piece of legislation, but one which did not attempt to change all aspects of health care. Its attempt was to make sure that everyone

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