Kennedy was the key figure in last week's Senate approval of a drug benefit and modest Medicare reforms. Without his support, the measure would not have passed. By backing it, Kennedy angered many liberal Democrats who want a more lavish benefit and no reform of Medicare at all. But Kennedy decided it was time to grab a Medicare compromise backed by President Bush and improve it later along liberal lines.
Oddly enough, Kennedy agrees with the analysis of the legislation by conservative critics who want to take Medicare away from the federal government and run it through private insurance companies. Conservatives fear the new legislation will have the opposite effect, keeping seniors in the traditional Medicare system where they'll miss out on free market reforms. Which is exactly what Kennedy wants to happen. He openly says the measure would kill privatization of Medicare, which is a big reason he supports it and conservatives oppose it. "If you think Medicare should be privatized, then you should oppose this bill," Kennedy said in a speech on the Senate floor last month.
The Bush administration takes a different view. It calculates that 48 percent of Medicare recipients would jump to private insurance under the bill, which was negotiated by Chairman Charles Grassley of the Senate Finance Committee under the watchful eye of majority leader Bill Frist. After all that attrition, old-fashioned, government-run Medicare would gradually fade away. Kennedy and conservative opponents don't believe this, and neither does the Congressional Budget Office, which says no more than 12 percent would jump to private plans. The administration originally demanded a strong incentive for seniors to switch: They wouldn't get the drug benefit unless they did. But this provision has been jettisoned. Now seniors would get the benefit either way.
So why is Kennedy wiser than anyone else in dealing with Medicare, wiser than his liberal colleagues and the White House? Because he, unlike them, has figured out how to get what he wants.
For starters, Kennedy is prepared to seize the current opportunity to add a prescription benefit, having seen numerous other opportunities missed. He argues that deficiencies in the Bush-backed bill can be eliminated by the next Democratic president and Congress. My guess is he doesn't really expect Democrats to regain control of Washington any time soon. But he sees the legislation (correctly, as far as I can tell) as the last chance for a long time to get a prescription drug benefit. "We must get started," he said.
When he was majority leader, Daschle could have gotten the same deal. But because he wanted to use the absence of a drug benefit against Bush and Republicans in the 2002 election, he didn't act. Daschle and Kennedy view things differently. Daschle is chiefly interested in exploiting issues for political gain. Of course, Democrats reaped little advantage from the Medicare issue in 2002, as national security dominated the campaign. Kennedy is interested in legislative accomplishment, in getting things done, liberal things. If that requires settling at times for a foot in the door, he's agreeable. And this time, it's a big foot in the door. Sure, Bush will claim political credit, but Democrats will get some, too. That's what happened when Kennedy compromised with Bush on an education reform bill in 2001.
Democrats would get nothing if they followed the advice of Hillary Clinton. She is notoriously inept at judging what can get through Congress. Recall the health care scheme she concocted in 1993 that was summarily rejected on Capitol Hill. Now she says: "We do not want to rush through this legislation at the risk of getting it wrong." She would make the perfect (from a liberal standpoint) the enemy of the good. Kennedy wouldn't.
What about hotheads like Rockefeller who say the Medicare legislation will play into the hands of those who want to kill traditional Medicare? Advocates of free-market Medicare, and I'm one of them, don't think it will happen. The Rockefeller types are reactionary liberals who would preserve and expand every government program outside of the Pentagon, no matter the cost or resulting inefficiency. No change is acceptable to them. Kennedy, however, is not a standpatter. He recognizes that to get a drug benefit, liberals have to give up something, at least in the short run.
Kennedy is gambling. He kept abreast of talks as Grassley and Democratic senator Max Baucus reached a compromise and quickly endorsed it. He's gambling the incentives to lure seniors to private health insurance plans, contained in the Medicare bill passed by the House, will be weakened or dropped when the House and Senate meet in conference to hash out the differences in their bills. He's probably right. Bush, who needs a domestic policy triumph, can't afford to have Kennedy drop his support. Another gamble is that the measure, which would go into effect in 2006, will not prompt a migration out of government-managed Medicare. Bush believes it will. They can't both be right.
Fred Barnes is executive editor of The Weekly Standard.