Published In The Washington Times, May 1, 2003

By James L. Martin

“Enemies of Medicare modernization are just as adept at psychological warfare as the U.S. military — maybe even more so, since they have more actual field experience.

If there was some good reason, beyond nostalgia, for preventing reform of the creaking health-care system for America’s seniors, their behavior might be understandable. But Medicare is a financial catastrophe and human tragedy in the making. And blocking reform is a sure guarantee that today’s worst-case scenario will become tomorrow’s worst-case reality.

If this was a military campaign, we might describe the strategy being employed to block reform as “attack and run.” Opponents of Medicare reform attack; those allegedly favoring reform — at this stage, mostly congressional Republicans — run. On the one side we have dishonesty. On the other side: cowardice.

Let’s make it very clear that the Democrats are speaking out and out untruths on the matter of HMOs. They state over and over that the President is trying to force seniors into HMOs. Here is a direct quote from the President in his State of the Union Message.

“Instead, we must work toward a system in which all Americans have a good insurance policy, choose their own doctors, and seniors and low-income Americans receive the help they need. Instead of bureaucrats and trial lawyers and HMOs, we must put doctors and nurses and patients back in charge of American medicine.”

President Bush has put forward the most intelligent, forward-looking reform plan in Medicare’s history. If implemented, as it should be, Medicare beneficiaries would have several options, not just today’s one.

First, they could remain in the current system, which gives you your choice of doctors and other health-care providers, but with important strings attached. Currently, there is no prescription drug coverage under Medicare, nor is there coverage for break-the-bank catastrophic illnesses involving extended hospitalizations.

There is consensus for adding some sort of drug benefit, though the system in its current form couldn’t bear the cost. That is why President Bush correctly wants to tie drug benefits to overall reform of the program.

Catastrophic coverage is another matter. Congress amended Medicare in 1988 to provide coverage for catastrophic illnesses. The Medicare Catastrophic Coverage Act of 1988 provided unlimited annual hospital coverage, 150 days of skilled nursing care, unlimited hospice care, 38 days of home health care — and was repealed, amid mounting controversy, just months after being signed into law.

So there are gaping holes in the current system, and little money to patch them up. To stave off financial collapse, the Medicare bureaucracy has (for years) been reducing the fees it pays doctors and other providers, causing increasing numbers to drop their elderly patients. For many seniors, having a “choice” of doctors is really a fiction. If the doctor you want no longer accepts Medicare patients you’re out of luck.

Even Medicare’s trustees admit that long term, when the Baby Boomers retire, there won’t be enough money to keep the program going, even without the additional (and necessary) benefits. That’s why President Bush correctly wants to modernize the system.

Under the President’s plan, seniors would be free to stay in the current program, even with its flaws. But they could also opt out, purchasing, instead, a private health plan, including those offered by health maintenance organizations (HMOs) and preferred provider organizations (PPOs), which would compete for their business.

Why congressional liberals like Sen. Teddy Kennedy, D-Mass., haven’t embraced the President’s proposal is truly amazing, because it’s the mirror image of the health-care program that provides coverage for members of Congress, the congressional staff, postal workers, White House employees, and some nine million other federal workers, retirees, and their dependents.

The Federal Employees Health Benefits Program (FEHBP), which has been around for more than 40 years, provides federal employees and retirees with a range of choices: all of them good. All FEHBP plans, for example — even the most basic — must offer a specific set of “minimum” benefits, including catastrophic coverage. Because the FEHBP health plans must compete for business, virtually all of them include prescription drug coverage and other “extras” not included in Medicare.

Best of all, if you enroll in a plan and decide you don’t like it, you can transfer to another: a guaranteed right.

In the President’s view, and in ours, if such a system is good enough for Congress and the federal workforce, it should be good enough for the rest of America. So there is only one logical reason for opposing such a plan: politics.

Unfortunately, that only explains the actions of congressional Democrats, many of whom have reaped great advantage over the years by telling seniors the Big Lie: that Republicans are out to destroy Medicare. There are notable exceptions, of course, such as Sen. John Breaux of Louisiana, who supports the types of changes proposed by the President. But Senator Breaux stands in the minority within his party.

The behavior of congressional Republicans is more difficult to understand. Instead of supporting the FEHBP-type reforms, many Republicans are running as far and as fast as they can from the President’s plan. The only possible explanation is cowardice.

This is a reform plan worth fighting for. Members of Congress who want choices for themselves, but don’t want seniors to enjoy similar choices, should hide their heads in shame.