MANAGED CARE January 2001. ©MediMedia USA
Some things presidential candidates promise are later forgotten. Blame our curiosity, then, for suggesting that one idea floated during the campaign merits examination: George W. Bush's assertion that he would reform Medicare in the image of the Federal Employees Health Benefits Program.
John F. Kennedy remarked that one of the most surprising things he discovered as president was how little control over events he possessed. Bush, unfortunately, may be in for a similar awakening.
As senior editor Frank Diamond's cover story [1] points out, many people have held the FEHB program up as an example without realizing how difficult it would be to replicate. Talk, in other words, is cheap.
While the article doesn't specifically address Medicare and the FEHB program, experts almost unanimously opined that the system could possibly be expanded — but only by baby steps. Ed Flynn, the associate director for retirement and insurance for the Office of Personnel Management, which runs the system, labels more grandiose notions as "simplistic."
Even expanding the FEHB program into the private sector would be difficult, because such a move would represent an administrative burden for smaller companies. (Bigger companies try to offer as much choice as the FEHB program, but how many companies have nearly 9 million employees?)
Still, there is no denying that the FEHB program has trans-ideological appeal — Democrats, as well as Republicans, have sung its praises. Why not? It applies government oversight — as opposed to interference — to a system in which 245 health plans must compete like crazy for business.
As one expert put it, there are "hundreds of nuances where the FEHB program is better than Medicare, because plans that don't have nuances don't keep customers."
In that sense, candidate Bush was on to something. Let's see what President Bush can do with it.