It hits this week. After months of focus-grouping, number-crunching and brave talk, the GOP will disclose its plan to slice $270 billion from the growth of Medicare spending between now and the year 2002. The plan will generate the political equivalent of a Great Plains twister. Republicans will vow to “preserve, protect and improve” Medicare-and Democrats will launch a vicious counteroffensive backed by an army of the organized elderly.
Medicare is life and death to 37 million Americans. After social security, it’s the costliest and most cherished program in government-and has been ever since LBJ handed the first Medicare cards to Harry and Bess Truman. Thirty years later, the GOP will now propose a seismic shift in philosophy: the use of market forces to achieve government’s aims. The GOP plan would push patients into competing, for-profit health-maintenance organizations, where the freedom to choose doctors is limited–and cost control is far from certain (page 42).
For Republicans, the stakes are enormous.Slowing the growth of Medicare is key to balancing the budget-and to convincing the public that the GOP stands for humane change. Having flinched from taking on social security, they can’t back down now. Medicare reform “is absolutely at the heart of what we’re trying to do to get the country back on track,” Gingrich declared to NEWSWEEK.
Democrats speak in equally epic terms. They know Republicans can’t pay for their “crown jewel”–$245 billion in tax cuts–without Medicare savings. They think an emotional Bill Clinton can defend the essence of the Great Society. They believe that they can win–and must. “It’s a fight for what it means to be an American,” says Health and Human Services Secretary Donna Shalala.
Facing a deadline to act by the middle of next month (when the government will go broke without new borrowing authority), Congress will soon resemble the hospital in “E.R.”: a contentious operating theater full of panic, foul language and blood.
The first war is over words. Republicans have developed an upbeat, market-tested lexicon. A new seniors’ tax break for medical expenses is a “health bank.” Joining an HMO is a “Medi-choice.” Means-testing-requiring the wealthy to pay more–has been renamed “affluence testing.”
“Cut” is the unkindest word of all. In TV spots running in dozens of districts -including Greg Ganske’s – Democrats repeat the word “cut” with the frequency of an infomercial for Ginsu knives. Republicans prefer to say–rightly-that they are “slowing the increase” in Medicare spending by $270 billion. Gingrich notes that per-patient Medicare spending will rise from $4,800 today to $6,700 in 2002. But the GOP’s own documents show that Medicare recipients will inevitably see new restrictions in coverage: higher premiums for visits to doctors, or stricter rules on tests.
Context is as important as words. The GOP has focused on Medicare’s precarious finances, and the message is getting through: most voters now believe there is a threat to Medicare’s long-term solvency. Gingrief wants to be seen as the program’s savior, not its executioner. So he will insist on a “free-standing vote” on the GOP’s plan. “This is about strengthening Medicare, nothing else,” he told NEWSWEEK.
Still, Democrats depict the GOP’s Medicare plan as a bloodthirsty attack on the elderly. “More people will die,” declares a hysterical new ad from the AFL-CIO. And “it’s only for the sake of tax cuts for the rich,” says Democrat Ed Markey of Massachusetts. That’s hyberbole, for sure. But it is true that $100 billion of the GOP’s projected Medicare savings would go into the general Treasury–and thus, in a sense, would help pay for everything in the GOP budget, including tax cuts.
Beyond words and context, timing is all in medical-care reform. Bill and Hillary Clinton learned that the hard way. They concocted a vast plan in secret, then presented it long before legislative action was necessary. It was picked apart-and to death-before it ever got to committee.
Gingrich’s game plan is opposite in every way. Starting last spring, he instituted a series of public forums–he held his own last weekend in Atlanta–and even a “Medicare University” on C-Span. The aim was to take political soundings-and to stall for time. This week he’ll unveil the outlines of a GOP House bill: a new dependence on HMOs, “Medicare Plus” for those who want to stick with the old system and higher premiums for wealthy recipients. There will be little time for debate in the trauma-unit frenzy generated by the need to enact a budget and raise the ceiling on the national debt.
As for Ganske, he’s ready to face the storm ahead. He says he’ll work to make sure the legislation includes strict rules on HMOs. He’ll fend off attacks from Democrats, who held his district for 86 years before his victory last November. Meanwhile, he is applying for privileges to practice his specialty-reconstructive surgery-at hospitals near the Capitol. It’s a way to keep in touch with the real medical world. It’s also away to keep his doctor’s skills sharp. Given the political risks he now faces, that may be the prudent thing to do.
