By KATE O’BEIRNE
President Clinton’s recent Medicare reform proposal, including a new prescription-drug benefit for beneficiaries, has received a wary response from congressional Republicans. The lessons learned from recent health care reform efforts justify their caution. Lawmakers seeking political advantage by tampering with government-run health care should heed the physicians’ creed: First, do no harm.
The patient is not the only one in jeopardy when Washington follows the wrong prescription for health care reform. Politicians risk the wrath of voters unhappy with their handiwork. Congress ignored this admonition in 1988, when expanded benefits for Medicare passed overwhelmingly.
Only 11 senators voted against the Medicare Catastrophic Coverage Act of 1988, which included prescription-drug coverage and enjoyed the enthusiastic support of the American Association of Retired Persons. A year after President Reagan signed the bill, it was largely repealed by Congress at the behest of the American people. Although polls had shown that 80 percent of the public supported the legislation, within months of its signing, lawmakers were hit by a public backlash.
Literally. On Aug. 18, 1989, the Chicago Tribune reported: “Congressman Dan Rostenkowski, one of the most powerful politicians in the United States, was booed and chased down a Chicago street Thursday morning by a group of senior citizens after he refused to talk with them about federal health insurance. [He] cut through a gas station, broke into a sprint and escaped into his car, which minutes earlier had one of the elderly protesters, Leona Kozien, draped over the hood.”
Rostenkowski plaintively explained, “These people don’t understand what the government is trying to do for them.” But, older people understood perfectly what the government was up to. They were being asked to pay for benefits that they figured were not worth the extra costs.
Ten years later, the president is promoting a prescription-drug benefit that two-thirds of the elderly already have either through private insurance or Medicaid. Only 14 percent of seniors spend more than $1,000 per year on prescription drugs. But, rather than design a program that focuses its benefits on the small group that needs the help, the president proposes a universal benefit.
To control costs, only approved drugs would be covered, and, inevitably, price controls will be introduced. Even with the initial restrictions on choice of medications, increased premiums and co-payments, the additional benefit is estimated to cost $80 billion over the next several years.
Experience tells us that cost estimates accompanying the introduction of a new goody from the federal government are wildly inaccurate. Back in 1988, the drug benefit was estimated to cost $5.7 billion. A year later, the estimated cost had jumped to $11.8 billion. The president included a drug benefit, estimated to cost $66 billion, in his own health care reform package in 1995. At the time, Sen. Daniel Patrick Moynihan, D-N.Y., called the estimates for the health care system’s overhaul a “fantasy.”
When the new program inevitably costs more than current projections, either seniors will pay more, or taxpayers will pick up the tab. A program already threatened with bankruptcy and bracing for the retirement of Baby Boomers will incur the uncertain future costs.
Republicans’ timidity has prevented their critical analysis of the president’s proposal because they dare not get on the wrong side of opinion polls. As in 1988, 80 percent of the public favors a Medicare prescription-drug benefit in theory. The details of the president’s plan, however, reveal that seniors will be asked to make the same tradeoffs they refused to accept 10 years ago. Republicans should not fear saying so, and they should offer an alternative plan to address the hardship faced by some beneficiaries.
The president’s plan, which builds on the status quo, has opened a dialogue on the future of Medicare. Let the debate begin. There is an alternative bipartisan reform plan that would include prescription coverage in a major restructuring of the program. Sen. John Breaux, D-La., is the chief Senate sponsor of the proposal that introduces competition and choice to hold down costs.
Congress should heed the lessons of the past and spare the elderly unpleasant surprises. Presidential candidates should declare their own positions on reform, so that a well-informed mandate determines the future of Medicare. With the opportunity to engage in a real debate on detailed reform proposals, older Americans will not have to become hood ornaments on legislators’ cars to get their attention.
Kate O’Beirne is Washington editor of the National Review. She is a contributing editor of IntellectualCapital.com.
