The Magazine

MEDISCARE, AGAIN

Feb 2, 1998, Vol. 3, No. 20 • By MAJOR GARRETT
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Speaking of Bill Clinton's power to seduce: He is luring the GOP Congress into surrender on Medicare.


The 1997 budget deal contained an implicit promise from Clinton and the Democrats to observe a truce on this issue -- no tricks, no campaign-trail taunts. And implausible as it seemed, Republicans fell for this seduction, forgetting how Democrats have used Medicare as a tire iron against them in every election since 1980, forgetting how Clinton had deceived them in the 1995 budget negotiations, forgetting how he and other Democrats had blatantly lied about Republican plans for Medicare.


In the '97 budget deal, Clinton and Congress agreed to trim future Medicare expenses by $ 115 billion over five years and to convene a bipartisan commission to handle the issue. The deal appeared to offer full political cover in 1998: a moratorium on attacks against imaginary Medicare cuts, plus a boring commission that would stifle volatile debate about Medicare's future. (The program is headed toward insolvency in 2007.)


Then came the double cross. The president announced this month his intention to offer Medicare coverage to a group of people called the "near- elderly," a small cohort of Americans (fewer than 14 percent of the general population, according to the Census Bureau) who, for various reasons, cannot obtain health insurance. Clinton intends to allow all Americans aged 62 to 64 to buy into Medicare for $ 300 a month. And he wants to charge the unemployed who are 55 and older $ 400 a month for the same privilege.


"They came back from the budget deal with a flimsy piece of paper on Medicare," says one Republican strategist. "The leadership has been Neville Chamberlained." Clinton's proposal is indeed as shrewd a trap as he has laid on Medicare -- far shrewder than the ostensible cease-fire he offered last year.


To begin with, the Clinton proposal makes Medicare an issue once again, with mid-term elections looming. Already, Republicans are girding for Medicare attacks in congressional districts where they had counted on a free pass. This doesn't mean those candidates will lose; but it does mean Republicans will have to raise more money and devote more time to building a rhetorical defense, which will distract them from, among other things, pushing for tax cuts.


Republicans who believe that Clinton's Medicare parry is merely a sop to his disgruntled Left are deluding themselves. As senior presidential adviser Rahm Emanuel explained it to the New York Times, "The Republicans want to talk numbers. We will talk about individual real-life stories. And we will keep pounding the Republicans until Congress approves our proposal." It appears that Clinton wants a year-long debate on Medicare as the rescuer of 300,000 or so distressed "near-elderly."


His transparent goal is to force Republicans into ritualistic denunciations of Medicare expansion. And Senators Trent Lott and Phil Gramm have already obliged. The terms of the debate are thus established: Clinton is compassionate; Republicans are not. The president will hammer this theme in his State of the Union address -- he now has more incentive to do so than ever -- and Democrats in the House chamber will thunderously applaud. (What Republicans will do, we can only imagine: hiss? scowl?)


Though objections to Clinton's proposal are mathematically foolproof, they are politically problematic. Gramm correctly points out that those willing to pay annual premiums of more than $ 3,600 for Medicare are probably facing serious health costs -- otherwise it would make no sense for them to pay so much for an annual check-up and flu shot. He and others argue that these new recipients will consume far more health care than they pay for. "Any time you expand an entitlement, the costs go up," says Rep. Dan Miller, a Florida Republican and party leader on Medicare.


Moreover, to encourage people to retire before age 65 is to aggravate the problems of both Medicare and Social Security, which feed off payroll taxes of 15.4 percent. Also, an extension of Medicare coverage could lead the private sector to dump some of its "near-eligible" employees from its health- insurance rolls. Last, if Republicans ever concede that the "near-eligible" need help in obtaining coverage, Democrats will demand subsidies for the unemployed 55 and older and those 62 to 64 who can't afford Clinton's pricey premiums. This would further drive up Medicare costs and accelerate the program's grim march toward insolvency. But, for the Democratic party, it would be mighty good politics.