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Critical Condition

NRO’s health-care blog.

Party of Medi-Scare?



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Bruce Bartlett has a piece in Forbes criticizing the GOP for becoming the party of Medicare. His argument is that while Republicans initially opposed Medicare and have long criticized it, the combination of President Bush backing prescription drug coverage under Medicare in the Medicare Modernization Act (MMA) and RNC Chair Michael Steele’s recent Senior Bill of Rights, which opposes paying for President Obama’s health reform with Medicare cuts, indicate that the GOP has sold out to seniors on this issue.

A few points need to be made in response. First, Bartlett is right that Republicans are no longer inveterate Medicare bashers. To be such would not only be politically unviable, but also ignores the reality of Medicare and how important it is. Republicans cannot realistically wish for a half-trillion-dollar program that serves over 40 million seniors to just go away, much as Bartlett, and perhaps other conservatives, might want them to. What Republicans can, and should, do is criticize Medicare’s problems: its cost, its endless rule book, which is longer than that of the IRS, and the inevitable — and the immense — frauds perpetuated by criminals pretending to be Medicare suppliers. They should also use the spectre of Medicare’s impending bankruptcies — the hospital trust fund is scheduled for insolvency towards the end of the next decade — to warn about the dangers of further government encroachment into health-care financing.

As for the Bush and Steele examples, the story is not so simple as Bartlett portrays it. With respect to the MMA, prescription-drug coverage under Medicare was both inevitable and necessary. Necessary because it was unrealistic and cruel to maintain a health-benefits program for seniors that did not include outpatient coverage of prescription drugs. When Medicare was created in 1965, pharmaceutical products were not part of the standard regimen of outpatient care. Thanks to tremendous technological advances in the last four decades, made largely by American pharmaceutical companies, new therapies have become available that extend and improve lives on a daily basis. By having drugs only available for in-patient care, pre-MMA Medicare encouraged unnecessary and expensive hospitalizations, and also seemed arbitrary and capricious in refusing to pay for needed prescription drugs in one setting but not another. This approach constituted one of those illogical governmental actions that conservatives rightly criticized, and should criticize in the future. Furthermore, Democrats were hammering on Republicans in election cycle after cycle for refusing to provide drug coverage under Medicare, when it was the very program that Democrats had created and championed that was causing the problem.

Faced with this situation, President Bush did two smart things. First, he stopped the political bleeding by saying that he supported prescription drug coverage under Medicare. This was an important piece of his message in 2000, without which, I suspect, he never would have won his hair-width electoral victory over Al Gore. Second, he said that if the federal government were going to provide such coverage, it would have to be done in a different way from the traditional Medicare program, and he succeded in making that happen. Medicare Part D asks seniors to choose a prescription-drug plan that works for them, which both injects choice into the system, and controls cost. 90% of seniors do the research and choose something other than the standard, government created drug plan. Although Part D is certainly expensive, its choice mechanisms have helped bring the program in at $150 billion under the projected cost for the 2004 to 2013 budget window. And the choice element allows Republicans to demonstrate that seniors, and in fact all consumers, can make choices in health care, and that this simple market mechanism can and does bring projected costs down.

As for the current debate, the RNC is somewhat vulnerable to the charge Bartlett levels. Looking at the language, however, it seems to me, and I confirmed this with RNC officials, that the Senior Bill of Rights was written in such a way as to oppose cutting Medicare for the purpose of President Obama’s trillion dollar health-reform package. It does not categorically reject reductions in the rate of Medicare growth, which inevitably get labelled as “cuts” by the opposition. It is likely that there will have to be a bipartisan agreement at some point on controlling Medicare costs. The RNC approach does not preclude Republican support for such an agreement.

Bartlett further makes the strategic point that Republicans should let Democrats do the hard and politically tough work of making the first crack at politically unpopular steps to salvage Medicare’s finances. I don’t think the RNC approach prevents this, and I don’t think the apparent strategy of wishing Medicare went away is viable, or appropriate, for conservatives, Republicans, or both.



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