Editorial Do no harm
Steinfels, Margaret O'Brien
Do no harm Hast year's obstructionists to health-care reform have become this year's champions. Bill Clinton's failed overhaul, spurred by ballooning expenses, was aimed at expanding both access...
...Between 1975 and 1990, Medicare costs rose less rapidly than medical costs in general, because strict government reimbursement programs kept the increase of hospital expenses at a rate of 2 to 3 percent...
...This year's Republican effort has a different goal...
...It also means Medicare must live within a strict budget, but not one that will cut off providers and medical institutions at the ankles, crippling the whole system as the Republicans' massive cuts (not only in Medicare but Medicaid) now threaten to do...
...The complexity of Medicare reform lies in the program's many-layered political history...
...Still, Marmor argues, all is not lost...
...Medical reform is a battle with a seven-headed hydra...
...Bill Clinton's failed overhaul, spurred by ballooning expenses, was aimed at expanding both access and coverage for all Americans...
...Second, Medicare must come to terms with the issue of finite resources...
...Change must be gradual, to reassure beneficiaries and providers alike...
...Despite the role reversals and the hemispheric shift in aims, some sort of healthcare reform-at least when it comes to Medicare-is now a political possibility...
...Clinton argues this would be less disruptive to seniors and to the medical system, and he's right...
...The Republicans' proposal that more affluent enrollees pay higher premiums (an important step toward means-testing), ought to be championed by Democrats...
...Finally, Medicare will have to charge beneficiaries more, but not so much that it will force some out of the system...
...Should they fail to do so, their reimbursement will be cut more deeply the following year to balance the previous year's books...
...It is an idea whose time has come...
...Medicare ought to be a permanent, unassailable component of the social contract in America...
...Then, by incorporating the insurance industry as intermediary in the payment process (to reassure that pillar of the economic system), government weakened its capacity to control costs...
...That means rooting out fraud and waste, and the Republicans have some good suggestions here...
...Today, they account for 34 percent of the federal budget, far more than the 19 percent consumed by defense...
...Additionally, with 37 million Americans enrolled in the program, Medicare is two-and-one-half times the size of the next leading insurer...
...How it is done will be critically important for every American family...
...Some government efforts at cost containment have been highly effective...
...By failing to establish a global budget for the program (politicians had to reassure providers this wasn't going to be "socialized" medicine), medical outlays mushroomed across the board...
...And why propose a $245 billion tax cut, primarily for the wealthy, at the same time you are raising Medicare premiums for those on fixed incomes...
...When it leads wisely, other insurers follow...
...As more and more Americans retire and live longer, the costs of Social Security and Medicare rise...
...Congress didn't buy it because of its complexity...
...And according to a study released by the Urban Institute (Washington Post Weekly, September 3), Medicare can be a competitive program, its administrative costs ranging from only 2 to 4 percent compared with 8 to 25 percent for private companies...
...Furthermore, since even with increased premiums the Republican goal will not be met, hospitals and medical providers will be forced to "pay for" larger savings by slashing their costs...
...The elderly deserve affordable, assured medical care...
...In the September Washington Monthly ("The Medicare Solution"), Ted Marmor writes that today's conundrum arises from earlier compromises deemed necessary to get Medicare out of the starting blocks...
...It must examine not only questionable expenditures but end extraordinary, uncalled-for, or wasteful care...
...One day, that idea ought to be applied to deficit reduction as well...
...The Republicans' self-imposed goal of slaying the deficit in seven years is hasty, unrealistic, and potentially disruptive...
...Republicans are right to put a brake on medical expenditures...
...The president concurs, but wants to proceed more slowly, cutting $124 billion from Medicare over ten years...
...That gives it tremendous leverage...
...To reduce the deficit, GOP leaders propose to trim the projected budget for Medicare-the government insurance plan that covers 37 million senior Americans-by $270 billion over the next seven years...
...It's a fiscal sleight-of-hand likely to threaten health-care services...
Vol. 122 • October 1995 • No. 17
