High marks for GOP Medicare plan Showdown votes coming: Democratic criticism found wanting on many points.

October 13, 1995

LET'S CHECK OUT complaints Democrats raise against a Republican Medicare package moving toward passage in the House of Representatives next week:

* Democrats charge monthly premiums paid by seniors will be increased. The current $46.10 premium would rise to $54 next January and to $87 by January 2002. Individuals with incomes of more than $75,000 and couples with more than $125,000 would incur an additional surcharge. So what's wrong with that approach? Means-testing of wealthier seniors is long overdue. And beneficiaries should pay their fair share to bail out a budget-busting program already running a cash deficit.

* Democrats charge there will be steep cuts in payments to hospitals, forcing many to shut down. True enough. But the need to impose clamps on soaring hospital costs has long been acknowledged. The closing of some hospitals is recognized in many localities, not least in Baltimore. Our only caveat: special provisions should be made to finance medical research in great teaching institutions.

* Democrats charge that doctors will try to funnel Medicare patients into managed care organizations. And why not? Working-age Americans are being forced by their employers into health maintenance organizations and managed care groups. It seems only fair that senior citizens should follow that trend. The House GOP plan gives Medicare beneficiaries a wide range of options, including medical savings accounts and traditional fee-for-service arrangements with doctors of their choice.

* Democrats charge that under a deal between the American Medical Association and the House Republican leadership, doctors will be permitted to form health care networks of their own in competition with health maintenance organizations (HMOs) and commercial health insurers. We have no objection to the idea of managed care networks in which doctors rather than shareholders of private corporations reap the profits, but both should be subject to the same standards of supervision.

Most Democrats acknowledge that large-scale reform of the nation's health care system is needed. They failed last year when they controlled Congress in passing Hillary Rodham Clinton's health plan. The First Lady specialized in making enemies; Speaker Newt Gingrich has made it his business to make friends, and the result is support from many groups and unimpressive opposition from others.

Medicare must be reined in, along with other entitlements pushing the nation ever deeper into debt. There are things wrong with the GOP legislative agenda, particularly its insistence on totally unjustified tax cuts. But in the end it is up to the Republicans to reform Medicare; Democrats are not up to the challenge.

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