gang,
looks like they are going to get Medicare first. Privatizing Medicare is much more likely with the Libermans running the Democrat party. marta
http://www.latimes.com/news/printedition/la-na-health28dec28004426.story
It's the Republicans' Turn to Find a Health-Care Cure
Unlike Clinton, who proposed universal coverage, the GOP has a free-market vision. By Ronald Brownstein Times Staff Writer
December 28 2002 WASHINGTON -- Eight years after Bill Clinton's attempt to restructure the health-care system nearly capsized his presidency, circumstances are propelling President Bush toward another confrontation with the enduring problems of cost, access and equity in American medicine.
Bush and the incoming Republican majority in Congress aren't considering reforms as sweeping as Clinton's failed proposal for universal health coverage. But with the system falling into a spiral of rising costs and declining access, Congress and the administration are approaching pointed debates on a daunting menu of health-care dilemmas.
Topping the list are questions about how to provide prescription drugs for senior citizens; reform Medicare before baby boomers retire; protect state public health programs facing potentially crippling cutbacks because of huge budget deficits; and, most perplexingly, reduce the number of Americans without health insurance, which is rapidly rising again.
In all, the interlocked problems are beginning to resemble the ominous conditions in the early 1990s that inspired Clinton's unsuccessful quest to guarantee coverage for all. "It's been almost 10 years since health care was on the national agenda," said Dr. E. Richard Brown, director of UCLA's Center for Health Policy Research. "It hasn't gone away."
For Bush, the growing anxiety concerning health care could prove a principal domestic vulnerability in a 2004 reelection campaign. But Republicans also see an unprecedented opportunity in the new year to redefine the party's image on an issue where the public has usually placed more trust in Democrats.
With the GOP set to control both chambers of Congress, and Bill Frist of Tennessee, a physician, emerging as the new Senate majority leader, Republicans may have their best chance to define a free-market vision of health-care reform. The question will be whether they can sell that vision to a public skeptical of many of the most powerful players in that market, such as insurance companies and drug manufacturers.
After relative calm during the boom years of the mid- to late 1990s, the health-care system today seems under stress from virtually every angle.
Rapid increases in pharmaceutical prices are straining the budgets of senior citizens and generating sustained pressure to provide a prescription drug benefit under Medicare. But that pressure is coming even as the steadily growing cost of Medicare -- fueled by the rise in medical costs and by the growing number of retirees -- is itself straining the federal budget.
Meanwhile, a renewed surge in the cost of health insurance, which had moderated in the mid-1990s, is pressuring employers and driving up the number of people without coverage. Health insurance premiums for employers jumped by almost 13% this year, the second consecutive year of double-digit increases and the largest one-year spike since 1990, according to a recent Kaiser Family Foundation survey.
While virtually all large employers still insure workers, the share of smaller employers offering coverage has dropped from 67% in 2000 to 61% now.
With fewer employers providing coverage, the number of people in the country without health insurance jumped by 1.4 million, to 41.2 million, during Bush's first year in office. That erased a steady decline from 1998 to 2000 that reduced the number of uninsured by more than 4 million.
With the economy still weak, most experts believe the number of uninsured increased even more in 2002 (though the Census Bureau won't report the final figures until September).
Compounding the problem, even as the availability of workplace insurance is eroding, a nationwide budget crunch is forcing states to retrench Medicaid, the joint state-federal program that provides coverage for the poor. California alone is considering cuts that would reduce its Medicaid rolls by 500,000 over the next 18 months.
Against that backdrop, some Republicans see dissatisfaction concerning health care as one of the greatest potential dangers to Bush in 2004. In a recent ABC/Washington Post poll, 33% of Americans said they approved of his handling of health-care issues -- a much weaker grade than he got for his handling of the economy, which was 50% in the survey.
The White House recognizes the vulnerability. Aides are putting out the word that health-care initiatives will have a prominent place in Bush's agenda for the new year.
When representatives of two dozen health industry trade associations were invited to the White House for a recent briefing with the domestic policy staff, Karl Rove, Bush's top political advisor, made an impromptu appearance and promised that the administration "would be aggressive and get things done," according to one source familiar with the meeting. "That is intended to send a signal, and it did," the source said.
But signaling interest and achieving results are different things. Republicans and Democrats remain sharply divided about how to confront the principal challenges in the health-care system, which could make it difficult for Bush to move his ideas through the narrowly divided Senate.
Still, Republican control of both chambers and the White House and the ascendance of Frist, who has specialized in health-care issues since arriving in Congress in 1995, could give the White House agenda new momentum.
Details on the White House health-care plans are being closely held and, by several accounts, still being finalized. But Bush already has made some of his priorities clear.
On the uninsured, Bush last year offered an agenda with several components. One element has broad appeal among liberals: increasing funding for community health centers that provide care to the uninsured. Bush also wants to expand medical savings accounts, a conservative favorite that provides tax-free accounts in which individuals can save money to pay most of their medical expenses while buying insurance only to cover catastrophic costs.
At the heart of Bush's agenda for the uninsured has been a proposal to provide tax credits to help individuals and families buy insurance.
Most Democrats and consumer groups oppose the idea because they believe the tax credits (as much as $1,000 for individuals and $3,000 for families in Bush's version) are too small to help many of the uninsured afford coverage. They also fear that subsidizing people to buy individual insurance will unravel the employer-based health insurance system, which provides coverage for more than three-fifths of Americans.
In recent years, the principal Democratic alternative has been expanding the joint state-federal public programs that cover the uninsured, especially the Children's Health Insurance Program. But some Democratic experts say that idea looks less viable because the economic downturn has left states without enough money to fund their share of the costs.
As a result, Democrats are increasingly discussing tax credits that would help employers fund insurance for their workers.
On Medicare, the Republican takeover of the Senate will increase the odds that the GOP can push through its version of a prescription drug plan for senior citizens.
With White House support, the House last year narrowly approved a $320-billion, 10-year plan to subsidize private insurance companies to offer prescription drug plans to senior citizens. But the Democratic-led Senate blocked the plan.
Republicans argue that providing the benefit through private insurers will give senior citizens more choices and flexibility; the vast majority of Democrats want to funnel more generous aid directly through Medicare, insisting that that will provide more uniform benefits and help keep down drug prices through the government's bulk purchasing power.
Since the 2000 presidential campaign, Bush has insisted that it makes little sense to add the drug benefit to the program without reforming Medicare. But he faces difficult decisions on how much reform to attempt.
In 2000, Bush endorsed "premium support," an idea advanced by Sens. John B. Breaux (D-La.) and Frist to fundamentally restructure Medicare. The vast majority of Medicare recipients now receive care under a traditional fee-for-service program in which Washington directly compensates doctors and hospitals.
Under the Breaux-Frist plan, Medicare would provide senior citizens a fixed sum (with low-income seniors getting more) to purchase private insurance from approved plans.
Supporters believe that approach would increase competition and eventually save money. But that idea generated intense resistance from Democrats and seniors groups, who argued it would sharply raise premiums for senior citizens who wanted to stay in the existing fee-for-service system, and also allow the affluent to buy better care.
Though many Republicans still would like to steer Medicare toward the premium support model over time, most expect the party to move cautiously in the near term.
Critics charged that the Breaux-Frist plan aimed to push senior citizens out of fee-for-service Medicare through higher premiums. Most expect the White House will now try to entice seniors into privately run plans by providing those who switch with more generous benefits, particularly for prescription drugs. If you want other stories on this topic, search the Archives at latimes.com/archives. For information about reprinting this article, go to www.lats.com/rights.
-- Marta Russell Los Angeles, CA http://www.disweb.org -------------- next part -------------- An HTML attachment was scrubbed... URL: <../attachments/20030103/ea0ae096/attachment.htm>