By Judith Havemann
Washington Post Staff Writer
Saturday, March 7, 1998; Page A05

The commission charged with coming up with recommendations to save the Medicare system met for the first time yesterday, and raised as one possibility the idea of redesigning the system from scratch.

In such a plan, the 17-member bipartisan group would take into account the tremendous changes in health care since Medicare was created in the 1960s and attempt to design a system to insure the elderly in a more efficient and comprehensive way.

The commission also intends to look into more modest ways of shoring up the system through incremental changes in the structure.

Medicare is projected to be solvent for another decade, until the nation's 77 million baby boomers start retiring. The program covers 38 million elderly and disabled people, but that number will almost double when all the baby boomers are retired.

Working toward a March 1, 1999, deadline, the commission needs the votes of 11 of 17 members to forward recommendations to Congress. It will meet at least six times, all in public, to air the issues, come to bipartisan agreement, and attempt to build support around the country for reform.

Once the commission makes its recommendations, it will be up to Congress to enact any changes and the president to sign them into law.

Although the commission members uniformly expressed optimism that they could agree on a plan to shore up the government's health care system for the elderly, divisions among the dissimilar members were evident even in the group's first meeting.

While Chairman John Breaux, the Democratic senator from Louisiana, and Rep. William M. Thomas (R-Calif.), the panel's administrative chairman, suggested that Congress should postpone consideration of a White House proposal to permit younger Americans to buy into Medicare, some members of the commission clearly disagreed.

Laura D'Andrea Tyson, the former White House economic aide who is now a professor at the University of California at Berkeley, said "we should not be in the position of telling Congress what to do on this." The Clinton plan would extend the benefits of Medicare to Americans starting at age 62, and to a small group as young as 55, if they are willing to pay the premiums.

One of the nation's most liberal congressmen, panel member Jim McDermott (D-Wash.), said he supports the buy-in and former Clinton health aide Bruce Vladeck said "there are those of us on the commission who are hopeful that the existence of the commission will not preclude Congress from moving ahead."

But Thomas said he did not believe Congress would move on Clinton's plan before the commission rendered an opinion.

Even so, McDermott said that the session revealed "a lot more common ground than I might have expected. . . . Everybody is always sweetness and light at the first meeting," he said, "it will be like that until we get down to the nitty gritty."