In late January, President Clinton proposed Medicare spending reductions over the next six years totaling $138 billion, a figure he characterized as "a halfway point" between his own final target last year of $116 billion and the $158 billion the GOP put on the table last year after at first insisting on $270 billion. The impact of the downward revisions (don't call them "cuts") would fall on HMOs, hospitals and to a lesser extent physicians.
Republican leaders welcomed the proposal, not stressing, for the moment, their onetime plan to make beneficiaries bear some of the burden.
But won't the Medicare commission, so highly touted during the election, be deciding these things, you ask? Maybe not. The players are pulling back from that once-hot idea — Clinton included.
In the Senate, Joseph Lieberman, a Connecticut Democrat, and Bill Frist, M.D., a Republican from Tennessee, also are concerned about health care quality, and not just Medicare. These senators wonder if federal regulation could have the unintended effect of discouraging innovation.
The federal government, Lieberman noted, buys more than 40 percent of all U.S. health care through Medicare, Medicaid and other programs. "How can we judge whether quality is going up or down?" he asked.
In the same meeting, Democratic Sen. Jay Rockefeller of West Virginia decried instances of legislators "playing doctor" — but warned providers that the only way to prevent it was to provide more uniformity of service.
Preserving Medicaid, of course, is the second administration theme. That program's annual growth rate, double-digit in the early 1990s, has sputtered back to about 7 percent and should maintain that level into the next century.
Some say the program does not even need to be "restructured," although it is still in the throes of being kicked back to the states (remember the block grant versus no block grant debate?). Should those who have advocated tinkering with the Consumer Price Index get their way, giant swags of deficit would be sheared away with the stroke of an accountant's pen. Pressure on Medicare and Medicaid would be somewhat assuaged.
The third presidential drumbeat will be helping the uninsured — look for a replay of last year's idea of providing six months of health insurance for eligible unemployed workers.
At the top of the list will be the more than 10 million uninsured children in the country. First, the 3 million eligible for Medicaid will be urged to get on board, with another million put on the rolls over the next four years. That leaves at least 6 million uninsured. Politicians in both parties, including Senate Majority Leader Trent Lott of Mississippi and Democratic Sen. Edward M. Kennedy of Massachusetts, are scrambling to get them some coverage.
Senate Minority Leader Thomas Daschle of South Dakota has a plan, costing up to $4 billion a year, to give a tax credit to families with annual incomes of up to $75,000. Kennedy is to cosponsor a bill to provide vouchers to purchase child-only coverage and coverage for pregnant women, at a cost of up to $9 billion.
The Republicans think they have been cast as the bad guys in this issue and are determined not to be naysayers, although they are keeping a steely eye out for attempts to expand health care coverage to all Americans and some say their opponents are using children as the opening wedge. Their own proposals — such as requiring recipients of the earned income tax credit to buy health insurance for their children — have a chilly ring. The Democrats are offering such cuddly solutions as giving the states the money to buy the policies and a refundable tax credit for poor families. Just think — all this is just beginning!
— Jean Lawrence