Gop Wants To Pull Plug On Medicare

It has been impossible for a Republican congressional leader to form a sentence lately without its containing the word “revolution.” The Republicans seem very proud of being Robespierre’s successors, wielding a guillotine against the welfare state.

There’s just one problem. If there is a change the Republicans are pushing that truly deserves to be called “revolutionary,” it is their transformation of the health system and their cuts - excuse me, “reductions in the rate of growth” - in Medicare and Medicaid. But when the subject turns to Medicare, the revolutionary talk disappears. No, no, say the Republicans, with Medicare they are not radicals but preservationists. They want to “preserve, protect and strengthen” Medicare.

We now know, thanks to the reporting of Michael Weisskopf and David Maraniss in The Washington Post, that these un-revolutionary words are on all Republican lips because they come straight from the polling and focus groups.

Indeed, Weisskopf and Maraniss caught the Republicans red-handed: Ever since last April, when the Medicare board of trustees declared that Medicare’s hospital trust fund faced “bankruptcy” in the year 2002, the Republicans have insisted that their proposals are not designed to finance tax cuts or anything grubby, but simply to save the system. But Weisskopf and Maraniss report that Republicans had big plans to change Medicare well before any trust fund report.

The Republicans’ congenitally candid national chairman, Haley Barbour, said he had “no idea there was a Medicare report,” but eagerly picked up on its findings as a rationale for a politically hard sell.

Fortunately, politicians are more honest than you’d think. They blurt out bits of truth which, as Michael Kinsley reminded us years ago, constitute their most damaging “gaffes.” Thus Senate leader Bob Dole ran into trouble when he said proudly that “I was there, fighting the fight, voting against Medicare because we knew it wouldn’t work in 1965.” The day before, Speaker Newt Gingrich derided Medicare as “the 1964 Blue Cross Plan codified into law by Lyndon B. Johnson” and “a government monopoly plan.” He said the agency that administers Medicare - and, it thus seemed plausible to conclude, Medicare itself - is “going to wither on the vine because we think people are voluntarily going to leave it.” Suddenly, Medicare’s saviors were unmasked as its executioners.

Now the Republicans’ problem on Medicare is not their effort to curtail future spending on it. Even the most partisan Democrats concede that the program’s growth has to be curbed. What’s wrong is that the Republicans are proposing much vaster changes in the program than they want to admit and could create a two- or three-tiered health system. As the Wall Street Journal’s Laurie McGinley and Christopher Georges wrote earlier this month, “the wealthy would come out ahead, the poor might be hurt, and those in the middle could get better benefits in return for certain restrictions - on choosing a doctor, for instance.”

Let’s be honest: Medicare is a program of “socialized medicine” that works. It “socialized” health care costs for the elderly, effectively spreading them across the whole society. It is “socialized” in another way, putting all of the elderly - rich and poor, sick and healthy - into one large insurance pool. As a result, Medicare gives the elderly more health choices than most other Americans have.

The rhetoric of “choice” surrounding so many of the Republican arguments can thus be misleading. Medicare is expensive precisely because it gives the elderly a lot of options regarding doctors, hospitals and care. The Republicans are not talking about expanding such specific medical choices, but about giving the elderly more choices among health plans, usually before they get sick. That could end up restricting their choices later, which is one reason why managed care saves money: Patients are limited to specific lists of doctors; the plans limit payments and ultimately decide what sorts of medicine are most cost-effective.

In principle, there is nothing wrong with this. But everyone should be clear that the Republicans’ approach represents a huge roll of the dice. The risks of the changes will fall mostly on the poorer, the sicker and the older among the elderly - especially if spending is cut too much, too fast. The danger is that the wealthier and healthier elderly will be drawn out of the fee-for-service plan and into voucher or “medical savings account” schemes. This will drain money from the traditional part of Medicare and make it less and less what it is today. It could well wither away.

Gingrich, despite his later denials, was quite candid in talking of a “very entrepreneurial, risk-taking model.” The Republicans clearly want to replace Medicare as we know it with a market-driven voucher system.

That’s a very big deal, and it ought not be confused with “saving Medicare” or cutting the budget. President Clinton was much criticized last year for not accepting an “incremental” step-by-step approach to health-care reform. Now, it’s the Republicans who need to be told to slow down.

The answer is easy enough: After Clinton vetoes the Republican budget, the Republicans should find a politic way to admit they are moving too fast on health care, cutting too quickly and changing the system faster than most Americans really want. Then there could be serious talk about what cuts make sense and how managed-care options could be expanded with fewer dangers to the poor and the sick. If the Republicans want to “preserve, protect and strengthen” Medicare, their plan shouldn’t foresee its withering on the vine. This one does.