Managed Care for Medicare

May 05, 1995

Here's one statistic that ought to force official Washington to get serious about Medicare: While 60 percent of working Americans are enrolled in managed care plans, mostly under goading from their employers, only 7 percent of the elderly recipients of Medicare have joined such plans.

So is the answer to push the nation's 32 million old folks into managed care plans? To be sure, such a step would not be an instant remedy for Medicare's ills. So vast a change would take time to be implemented. And once it takes effect, the preventive care feature that has cut costs for younger Americans in Health Maintenance Organizations (HMOs) would not be as effective with an aging population.

Yet until a better idea comes along, managed care provisions should form an essential part of urgently needed legislation to bring Medicare (and Medicaid) under control. It should not be a mandatory program. No golden-age American should be forced into a managed care program. But those citizens who chose to stay with traditional fee-for-service arrangements that allow them select any doctors they want should be required to pay a premium. It's not only fair but it's logical to treat the working and retired populations roughly alike, especially when the graying of America will put more and more burdens on younger Americans.

While this is an issue crucial to Medicare reforms, it is currently being overshadowed by the political game-playing of Democrats and Republicans desperate to secure senior citizen votes in next year's elections.

It is, of course, amusing to watch Speaker Newt Gingrich squirm as he seeks to square his balanced-budget rhetoric with the harsh reality that this goal is out of reach unless federal spending on Medicare is reduced substantially. President Clinton adds his bit to the farce. Smarting over last year's health care defeat, he called only for incremental action in this area in his January budget. But now he says he won't cooperate with the Republicans until they move first to deal comprehensively with Medicare.

This has the GOP in a real fix. Having made both big tax cuts and a balanced budget key features of the "Contract with America, Republicans are having trouble coming up with the numbers to make this impossible combination work. The speaker's gimmick is to put Medicare off budget, which is a form of legislative denial. Senate majority leader Bob Dole's solution is to form a bipartisan study commission, a form of legislative burial.

The fact is Medicare solvency and a balanced budget are synonymous -- you can't have the one without the other. Add tax cuts to the federal revenue problem and you have an utter mess. This is the Republican dilemma and angry Democrats are not about to give them a helping hand. Politics rules in Washington, and the country be damned.

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