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This Will Hurt: Bush takes on Medicare
National Review, Feb 24, 2003 by Ramesh Ponnuru
Bush's advisers believe they have a better proposal this time. They have learned from conservative health-care experts, who say that private-sector health care is not a good model for free-market reform. Most private-sector employees, they say, have little choice among health plans because various government policies have distorted the market. The Heritage Foundation has long contended that a better model is, oddly enough, the health program that covers federal employees. That program gives beneficiaries a wide range of choices. They can choose HMOs, and around 40 percent of them do. But they can also get coverage from Blue Cross/Blue Shield, or from preferred provider organizations (PPOs), or from other types of plans. Competition keeps costs down, and choice keeps beneficiaries happy. In surveys, federal employees express high levels of satisfaction with their health coverage.
Bush's new program is based on the federal employees' plan. Republicans think the plan will be more attractive to voters than the 1995 proposal. Bob Moffit, a policy analyst at the Heritage Foundation, thinks that the fact that Bush is building on the federal plan will neutralize some of the Democrats' criticisms: "He's saying that senior citizens should have the same choices that members of Congress have. Does anybody seriously believe that over the last 43 years members of Congress . . . designed an inferior program for themselves and their families?"
For Republican optimists, the biggest difference between now and 1995 is President Bush. In 1995, the president was Bill Clinton, who blasted the Republican proposal in an unprecedented advertising campaign. The chief proponent of the reform was the abrasive and unpopular Newt Gingrich. Now the White House is occupied by a popular reformer. Says Republican strategist Ed Gillespie, "Having the megaphone on your side changes the dynamic entirely. . . . It is different when you're getting air cover from 1600 Pennsylvania [Avenue] rather than getting strafed by it."
Hill Republicans are going to need all the air cover they can get. The Democrats are gleefully rehearsing their old lines: Once again the GOP is said to be pushing old folks into HMOs. In his response to the State of the Union address, Gary Locke, the Democratic governor of Washington State, said, "[Bush's] plan only helps seniors who leave traditional Medicare. Our parents shouldn't be forced to give up their doctor or join an HMO to get the medicine they need."
Democrats have good reason to think the public will take their side. Political pundits have long described Social Security as "the third rail of American politics": Touch it and you die. But public support for Social Security reform has risen to the point where that's no longer true. Medicare, on the other hand, may be that third rail. As a political issue, Social Security calls to mind people's fears about their finances in old age. Medicare combines those fears with people's anxieties about their health in old age.
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