He is progressive in this regard.
One of the battle lines is about control of the vast finance involved. Am I not right that Greenspan has unusually specifically criticised the idea that such large sums of money invested on the stock exchange should be managed by state functionaries rather than by being dispersed to private individuals and for- profit capitalist companies?
The other big class issue is the range of the working class to benefit by a more rational (and probably cheaper and more efficient health system). Unfortunately this article looks as if Medicare is about patronising hand-downs to a mere 39 million of the population. The robustness of the British NHS through all the Thatcher years was that the "middle classes" benefitted greatly from it. I would strongly suggest that campaigners in the US will be inescapably reformist if they put their limited energies into a minority health care system rather than centrally into a rational socialised health care system for the great majority of the working population.
Chris Burford
London
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Medicare rescue plan
By ALICE ANN LOVE
Associated Press Write
March 16, 1999
Web posted at: 7:29 p.m. EST (0029 GMT)
WASHINGTON (AP) -- President Clinton
criticized a plan endorsed by several members of a
Medicare advisory commission, saying Tuesday that
it falls short of what's needed to shore up the health
care program for the elderly. So he said he will draft
his own plan in hopes of getting an agreement with
Congress this year.
"Every independent expert agrees that Medicare
cannot provide for the baby boom generation without
substantial new revenues," Clinton told reporters on
the White House lawn. The president has proposed
using billions of dollars of coming budget surpluses
for Medicare.
A plan endorsed by 10 of the 17 members of the
Medicare advisory commission would, in contrast,
aim to reduce the program's costs by making it more
like private health plans. Its chairman, Sen. John
Breaux, D-La., has raised concerns that
recommending the use of surpluses might simply ease
pressure on lawmakers to make difficult but
necessary changes.
"It is not a modern, efficient and effective program,"
Breaux said of Medicare.
As the commission met for the final time Tuesday,
Breaux acknowledged he would fall short of the 11
votes needed to make a formal recommendation to
Congress and Clinton, but said he plans to introduce
the plan in Congress anyway.
Senate Majority Leader Trent Lott, R-Miss., took
issue with Clinton's comments, noting that the
comptroller of the General Accounting Office last
week said the president's plan could "undercut the
incentives to engage in meaningful and fundamental
reform."
Clinton, for his part, called Medicare "too important
to let partisan progress stand in the way of vital
progress." * Breaux's plan would inject competition
into Medicare by letting senior citizens choose from
among private and government-run insurance
options. The government would subsidize their
premiums. * Clinton has proposed spending a chunk
of the coming expected budget surpluses -- about
$700 billion -- to boost the program. But he also
praised elements of the Breaux plan, and said some
of its proposed changes may be needed even if the
overall plan falls short.
"Even if all the changes recommended by the
commission were adopted, because of the projected
inflation rates and health care costs, it would not be
sufficient to stabilize the fund," Clinton said.
Without changes, Medicare, which provides health
insurance for 39 million elderly and disabled
Americans, is expected to run short of cash in about
a decade -- just before the first of the baby boomers
retire and become eligible for benefits.
However, tampering with the program has proved a
political lightning rod in the past. Republican leaders
and Clinton had hoped the bipartisan commission of
key lawmakers, private experts and former
government officials could take off some of the heat.
Instead, the commission has largely highlighted,
rather than solve, the political disagreements
confronting lawmakers looking to overhaul
Medicare.
Aside from Breaux himself, the only other Democrat
on the panel to support his plan was Sen. Bob
Kerrey, D-Neb. The other eight supporting it are
Republicans.
Breaux's plan would begin to shift Medicare away
from paying people's individual medical bills and
make it more like the health benefits that many
companies offer to workers.
One of the biggest unresolved Medicare issues is
whether more money is needed for the program, in
addition to restructuring. Republican leaders have so
far declined to endorse Clinton's idea of using budget
surpluses.
Most Democrats on the commission insisted that
even with changes to control costs, Medicare can't
provide adequate health care for growing numbers of
elderly Americans without more money.
Commissioners likewise clashed over their desire to
make prescription drugs -- not covered by Medicare
now -- more accessible to the elderly and disabled.
In general, Democrats including Clinton want to
subsidize drug coverage for all Medicare
beneficiaries. But Republicans wonder if the program
can afford that and want to explore other
private-sector options.
Similarly, the idea of raising the Medicare eligibility
age from 65 to 67 was attractive to many
commissioners of both parties. * Clinton said he
could not accept that idea, and also said he worried
that Breaux's plan could increase premiums for those
remaining in the traditional Medicare system.