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The Medicare Mess: Will President Bush call Congress' Bluff?

Tuesday, 17 June 2003 12:00 AM

Way back in 1994, then-first lady and now Sen. Hillary Clinton, toured America to promote her plan to take over American medical care. One of your Medicine Men (Cihak), attending her Seattle appearance, encountered a middle-aged gent who carried a neatly printed sign saying something like:

"Seattle wants health care like Congress has health care."

Somewhat naively, Cihak assumed that the gentleman was against the Clinton health plan, which featured government-dictated coverage instead of the choice that our employees in Congress have. But when discussing the differences between the Clinton proposal and congressional coverage, both became very confused.

The sign carrier also became rather upset when he discovered that, even though he favored HillaryCare, he was actually protesting against it.

We relate this Amusing Anecdote in order to make several points. The first is that, when it comes to legislating health care, very few Americans understand what's happening – even political operatives printing up protest signs.

Congress, however, understands. For generations, they have engaged in the willful destruction of American medicine for their own selfish purposes: a process well-captured by historian Philip Gold in his forthcoming book, "Disaster by Design: The Death and Rebirth of American Medicine."

And for generations, too many "conservative" presidents and members of Congress have either gone along or tried to use medical issues to score points with the voters and play games with the opposition.

It's happening again: The usual pattern of doing nothing, then trying to outbid the competition, then rushing to pass legislation that will only make things worse.

This latest iteration:

The Federal Employees Health Benefits Program (FEHBP) provides a wide range of choices for federal government employees, all providing generous benefits. Not surprisingly, Congress has been reluctant to tell non-federal citizens about it ... although during the HillaryCare debacle, some federal employees demanded assurances that their benefits would not be reduced to the level Hillary considered appropriate for the rest of us.

But President Bush tried to call Congress' bluff. Bush wants Medicare recipients to have the same range of choices that Congressmen and other federal government employees have had for over 43 years now.

Now, bluff-calling has a way of turning into runaway legislation. And since President Bush has raised the issue, Congress seems set on ignoring it as it scurries to pass yet another of its "No Time to Read It, Just Vote" bills.

In a not particularly artful dodge, Sen. Max Baucus, D-Mont., ranking member of the Finance Committee, admitted in a June 6 statement that "Some may take issue with the speed of our deliberations." However, "Sometimes there comes a time when you fish or cut bait. ... This year, the stars are aligned ... I have a good feeling about the progress we've made."

So, what's in this bill about which he feels so good and for which the stars have aligned and the fishing has begun? (Ah, such is the stuff of which mangled oxymorons are made.)

On June 12, The Senate Finance Committee passed "The Prescription Drug and Medicare Improvement Act of 2003" on a 16-5 vote, not available as a bill at the time of this writing. We do know that the proposal has several blanks to be filled in later.

We also know that wide choice for Medicare recipients is not one of the options. Rather, the proposal calls for the government to "pick only three low bidders to offer the private Medicare option in each area," according to a June 11 Wall Street Journal editorial, "The GOP's Medicare Surrender."

Bob Moffit, Ph.D., director of domestic policy studies for the Heritage Foundation, has been writing about the FEHBP for over a decade, and was once a federal executive himself. According to a June 6 WebMemo by Moffit:

" 'Competitive bidding' has emerged as a possible key element of Medicare reform. This approach is very different from, and incompatible with, the FEHBP model. Under competitive bidding, the government accepts what it considers the best bids, and allows only a limited number of providers or suppliers to participate. This may suffice for the purchase of desks, paper clips, or stationary. But it would interfere with a system of open competition and consumer choice, and lower the overall quality of care for Medicare beneficiaries."

Indeed, under the prescription drug coverage in the proposal, "Most employers will drop or scale back that coverage once they realize that the feds are willing to pick up part of their tab. The Congressional Budget Office estimates that 37% of those with employer coverage could lose it," according to a Wall Street Journal editorial.

So, there they go again. As it has for over 50 years, Congress is rushing to pass what Congress wants us to think is a voter freebie bill but which will actually work in reverse ... all the while pretending that it has to rush to get it done now, don't worry about the fine print, it'll all work out.

But it won't all work out. This is the process that gave us Medicare, and HMOs, and might have given us HillaryCare.

Not for nothing do we call it "Disaster by Design."

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a former president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail.

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Way back in 1994, then-first lady and now Sen. Hillary Clinton, toured America to promote her plan to take over American medical care. One of your Medicine Men (Cihak), attending her Seattle appearance, encountered a middle-aged gent who carried a neatly printed sign...
Tuesday, 17 June 2003 12:00 AM
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