Congress did balancing act to get Medicare bill passage

The word used more often than any other in describing the new Medicare overhaul and prescription drug bill was compromise.
Not that compromise is a bad thing; sometimes it even results in a well-balanced result. But Medicare has become such a complicated program and the prescription drug addition has such an enormous potential to bust the budget, that only time is going to tell whether this bill was a good compromise or a bad mistake.
The bill provides the greatest amount of prescription drug assistance to senior citizens at or slightly above the poverty level, which is as it should be.
But the bill also encourages the healthiest and wealthiest senior citizens to move into private plans, which will eventually place more pressure on Medicare.
Estimated cost
The overall cost of this bill is estimated at $400 billion over the next decade, and maybe twice that according to some calculations. The following decade, the cost could be as high as $2 trillion.
To paraphrase U.S. Sen. Everett Dirksen, a trillion here, a trillion there, and pretty soon you're talking about real money. Dirksen died in 1969, and back in those days, Congress was counting real money in billions.
A couple of years ago, when covering the rising costs of prescriptions for senior citizens began getting serious consideration in Congress, we expressed our reservations for expanding coverage without providing for a way to pay for it -- without adding to what was then a relatively small budget deficit.
The deficit is now huge, and the bill now headed to President Bush for his signature can only add to it.
The bill does more than address prescription drugs. The prescription drug industry's lobbyists were relatively quiet, confidant that the bill would provide a windfall for them. But other lobbyists worked hard for their constituencies, and managed to get goodies of one kind or another for insurance companies, hospitals and doctors in almost every kind of practice.
Prospect for future shock
Senior citizens who are rejoicing today in the prescription coverage they'll be getting have reason to worry about whether Medicare as they know it will be able to survive the additional costs. Baby Boomers who will start shifting to Medicare in about a decade have real cause for concern.
Some provisions in the 1,100-page legislation are meant to strengthen Medicare, such as health savings accounts, experimental Medicare competition with private health plans and higher premiums for some services for people with incomes over $80,000. But there is reason to doubt that those savings will offset the additional responsibilities Medicare has taken on with this bill.
Passing this legislation turned out to be a real balancing act in both the House and Senate. Sometimes, when a person tries too hard to keep his balance, he falls. If Congress slipped this time, it could end up taking Medicare with it.