Congress Ducks

THERE'S NO great mystery about how to address Medicare's financial crisis. Either you contain the rate at which the program's costs rise, or you raise more money to pay for it. The federal office that runs the health program for seniors recently announced progress of each sort. Unfortunately, Congress may undo both.

The first announcement was that spending on doctors is rising more slowly than in the past. But the announcement assumed that Congress will follow through on its promise to cut Medicare payments to doctors by 5 percent next year. Congress made that promise after two consecutive years of failing to follow through on similar ones. Lawmakers show every sign of reneging again, and they may even award doctors an increase -- in which case part of the apparent progress in protecting Medicare's finances by containing medical inflation will turn out to be illusory.

The second announcement was that the richest 4 percent or so of retirees will face steep increases in Medicare premiums. Until now, all patients have paid a premium equal to 25 percent of the value of the benefits that the average retiree receives. In the future, the most affluent will pay more, though they will still be paying less in premiums than they take out in benefits. This modest reform, which won't affect the premiums 96 percent of retirees pay, is expected to raise an extra $20 billion for Medicare over the next decade. That's a fraction of the program's long-term funding shortfall, but it's still worth having.

That's not the way some Democrats see it, however. Rep. Nita M. Lowey (D-N.Y.) is pushing a bill that would repeal the higher premiums, arguing that rich retirees should not be hit with increases because they have already contributed generously to Medicare via higher taxes. This is like arguing that the tax code is in danger of becoming too progressive -- a strange position for a Democrat. Ms. Lowey also worries that premium hikes may be extended to a broader swath of retirees, perhaps even to those with incomes of $30,000 or $40,000. That might raise harder questions. But we are not there yet, and it's worth remembering that retirees with that sort of income still are among the richest third of Medicare beneficiaries.

The entitlement programs are not going to be fixed without some hard decisions. If Democrats oppose modest changes that hit only the rich, how will they find the courage to support far-reaching reforms?