Beneath the surface, the debate in the House of Representatives on Thursday was not so much about the Medicare program itself as it was about partisan politics: about whether the Republican revolution will succeed and about whether Democrats can recapture the glory of the New Deal and the Great Society.
Politicians may agree on little else, but they agree on this: Next year’s elections and those for years to come could turn on how the public perceives the votes this year on Medicare.
That explains why the speeches Thursday were more tactical than explanatory, concerned more with resonance than truth. Both sides tailored their arguments to fit the public’s view, as expressed in opinion polls, that almost nothing the government does is as important as sustaining Medicare.
They had to stretch to do so.
Republicans maintained that their only aim is to save the popular program from bankruptcy. Democrats held, as Rep. Bill Richardson of New Mexico said Thursday morning, that under the GOP’s plan, “Medicare will end as we know it today.”
But no matter how often Republicans repeat their mantra about preserving and protecting Medicare - words carefully field-tested by their pollsters - they cannot escape the fact their true goal in overhauling Medicare is to raise money for their fiscal agenda.
And no matter how much Democrats pledge allegiance to Medicare, the creation of which was the crowning achievement of the last generation of Democratic lawmakers, they cannot escape the fact that fundamental changes are essential if the program is to survive.
A fiscal decision
Take the Republicans first.
In their “Contract With America,” the platform on which they won control of Congress last year, Republicans promised to cut taxes for middle- and upper-income Americans and balance the federal budget in seven years. The contract said nothing about Medicare.
But once they were in the majority in Congress, the Republicans realized they had to find the money somewhere to offset the lower taxes and to balance the budget.
With Social Security off the table, the only available pot was Medicare. Less than 12 percent of the budget now, Medicare would account for 30 percent of the lower spending in the Republican budgets over the next seven years.
This was not done for ideological reasons the way, for example, the Republicans want to cut welfare programs and turn them over to the states for administration. Nor was it it done because Republicans disapprove of the existing Medicare program the way, say, they object to environmental regulations.
The decisions on Medicare were made purely and simply to raise money - not to preserve and protect anything.
Republicans seized on the report this spring by Medicare trustees that the system would go bankrupt by 2002 unless spending was reduced or more revenue was raised.
But that was just a convenient excuse. The trustees had made similar reports for years without Republicans expressing anxiety. And the amount of savings the Republicans seek - $270 billion over seven years - is many times what would be needed to avert insolvency.
This is how the $270 billion figure was arrived at: First, the Republicans decided to balance the budget by 2002. Then they decided to cut taxes by $245 billion. Then they squeezed as much as they could out of all other government programs. At that point, they were $270 billion short of the money they needed. That’s how much they decided to take from Medicare.
But if the Republicans did not face up to the facts Thursday, neither did the Democrats. Not one Democrat alluded to the incontrovertible fact that taxpayers cannot afford to sustain the Medicare system as it exists today.
The Congressional Budget Office estimates that unless significant changes are made, the cost of Medicare will rise to $458 billion, or 18.6 percent of the budget, in 2005, from $178 billion, or 11.7 percent of the budget, in 1995.
By the second decade of the next century, when those in the baby-boomer generation begin to retire, Medicare will be swallowing such a large share of the federal pie that little will be left for anything else.
Today, about four workers pay taxes for each person covered by Medicare. The ratio will fall to 3.1 workers in 2015, to 2.5 workers in 2025 and to only two workers for each beneficiary in 2050, according to government estimates.
And consider this: Medical costs in the private economy have leveled off in the last couple of years as more workers have turned to - or been forced into - cost-efficient managed care systems.
But the cost of Medicare, virtually the last bastion of fee-for-service medicine, has continued to grow about 10 percent a year.
Rather than address this predicament, the Democrats, bereft of new ideas to counter the Republican offensive, returned to the same well they have relied on for years - the charge that Republicans are playing fast and loose with the well-being of the elderly.
Democrats are convinced, for instance, that they wrested control of the Senate from Republicans in 1986 by hammering on the theme that Republican senators had voted to lower Social Security benefits.
In the long term, lawmakers in both parties probably will face up to truths they preferred for political reasons to avoid Thursday.
If the Republican plan becomes law and insufficient funds are available down the road for high-quality health care for the elderly, Republicans most likely will intervene to provide whatever money is needed.
If, on the other hand, the Republican Medicare plan dies on the vine because of a presidential veto or for some other reason, it is an equally safe bet that Democrats ultimately will agree to make whatever changes are necessary to keep the program solvent.
But that’s the long-range outlook. In the short term, there is one certain prospect: The vote in the House on Thursday will be a dominant issue in next year’s election.