St. Louis Post-Dispatch: Americans have a love-hate relationship with Medicare, the federal health insurance program for the elderly. Those covered by the plan love it. Conservatives and free-market ideologues hate it.
So despite satisfied patients and unquestioned success, Medicare remains under relentless assault. Critics argue that it's too expensive, out of date and inefficient. To some extent, they're right (more on that later). But on the really big question -- what to do about it -- most critics are racing headlong in the wrong direction: toward privatization.
President Bush again added his voice to the critical refrain last week. He released a sketchy plan to "modernize and improve" Medicare. It would use the growing demand for a prescription drug benefit to fundamentally remake the program.
Bush's proposal drew a lukewarm response from Congress. Even members of his own party recognize that the $400 billion Bush would spend on a drug benefit over the next decade is insufficient. During that time, Medicare recipients will spend $1.8 trillion on prescription medicines. Bush's $400 billion, even coupled with billions more in potential savings, would cover only about a quarter of that cost. That's a Band-Aid, not a benefit.
Nor can Bush honestly claim that we don't have enough money to add a real drug benefit. He has already pushed through a $1.35 trillion tax cut, which would have covered nearly a decade's worth of prescription drugs for Medicare patients. Now he's asking for another cut of $1.3 trillion.
Faulty assumptions
Despite their moment of clarity, congressional Republicans share many of the same faulty assumptions as Bush. They are opposed by congressional Democrats who feel a sacred duty to protect an obsolete model for delivering health care.
Bush and his Republican colleagues are correct; Medicare needs to be modernized. It doesn't cover most preventive care. It doesn't cover prescription drugs. And it doesn't lend itself to new treatment approaches like the systematic management of chronic diseases. Congress can -- and should -- change all that. But the changes can be accomplished without privatizing Medicare.
Democrats are also right to argue that there are no magic formulas for saving money. Bush's reform "framework" illustrates the dogma of many conservatives that the private sector does a better job of holding down health spending.
That's not true, as corporate benefits managers can attest. Per-person health spending by government and the private sector has increased at about the same rate over the past decade. But millions of private-sector workers have lost coverage as the cost of insurance crept upward, and most others have been forced to pay an ever-larger share for drugs and medical care.