Inching toward reform

March 05, 2003

PRESIDENT BUSH is passionate, aides say, about winning reforms that will guarantee older Americans access to top-quality health care.

Medicare reform ranks on the Bush scale of concern, they say, right up there with Iraq, the war on terrorism and the economy, which is about the same place it scores on most polls.

Thus, the president advanced the long-delayed overhaul of Medicare yesterday by offering an ambitious proposal that acknowledges all beneficiaries must have help with prescription drug costs.

Breaking the stalemate on this highly volatile issue is going to require a lot more from him than that, however.

He's going to have to be highly flexible with lawmakers who really want a deal, firm with those in both parties who don't, and persuasive with many in the middle who fear his real intention is to dismantle this ever more costly relic of Lyndon Johnson's Great Society.

Medicare in its current form is among the most popular of all federal programs, yet it is inefficient, outmoded and fundamentally inadequate to meet the needs of the people it serves. In most cases, it doesn't cover prescription drugs, preventive care or nursing home costs.

Republicans for years have been promoting the notion of opening the Medicare market to private insurance companies as a way of introducing the greater benefits and cost-efficiencies of managed care. But an experiment with HMOs in the late 1990s was mostly a disaster.

Mr. Bush has offered a new approach, which administration officials say will work better because the insurance plans will be offered on a regional basis and function much like preferred provider plans that many government and private employees have now.

Medicare beneficiaries who sign up for such plans would get comprehensive drug coverage, preventive screenings and other extras. Meanwhile, those who stay in traditional fee-for-service Medicare would at least get 10 to 25 percent discounts on drug purchases and help with extremely high drug costs.

If there is a deal to be made, it probably will - and should - require that full drug coverage be provided to all Medicare beneficiaries. With a guaranteed drug benefit, everyone would likely be more willing to take a chance on revamping the program, and it would also enhance the government's ability to negotiate lower pharmaceutical prices. Further, it would have cost-savings benefits for Medicaid, which pays drug costs for the low-income elderly.

Democratic critics of Mr. Bush's proposals cheapen their position, however, when they resort to scare tactics, such as claiming he would rob Medicare patients of the freedom to see the doctor of their choice. Doctors take all kinds of insurance these days.

The president's proposal was offered only as a "vision statement" so Congress could fill in the details. If the lawmakers can agree how to meet that challenge, Mr. Bush will indeed have something to be passionate about.

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