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By Amy Goldstein
Washington Post Staff Writer
Tuesday, March 16, 1999; Page A1

A year after setting out to chart a secure future for Medicare, a high-powered federal commission is so deadlocked that it appears likely to collapse today when it convenes for the last time, without sending any advice to Congress or the White House, federal sources said yesterday.

Despite a frantic search for compromises in recent days, the commission's chairman, Sen. John Breaux (D-La.), acknowledged yesterday that he had not mustered enough votes for his vision of how to reform the nation's health insurance program for the elderly, and indicated that he would not win the one additional vote needed without an unforeseen breakthrough.

Breaux, typically a close ally of President Clinton, lashed out at the White House, saying the president had rebuffed his appeals "not once, but several times" to support the reform plan Breaux has advanced -- a plan that Breaux contended embodies Clinton's centrist Democratic beliefs.

"Do I wish the president had come out and endorsed this proposition? The answer is yes," the senator said at a late-afternoon news conference on Capitol Hill. "Am I disappointed he hasn't? The answer is also yes."

Last night, White House spokesman Barry Toiv resisted the suggestion that Clinton should have played a bigger role, particularly in influencing the commission's four White House appointees, all of whom appear likely to vote against the plan. "The president made the decision from the start to respect the independent views of his . . . appointees," Toiv said.

Although the outcome will not be sealed until the 17-member commission votes later today, Breaux's words appeared to foreshadow a remarkable end to the commission that had been born in an agreement between the Congress's Republican leaders and the White House. Loaded with members of Congress of both parties and leading health care policy experts, the panel was heralded at its inception as the best hope for producing an innovative and palatable way to address the enormous and politically touchy problems bearing down on Medicare.

A highly popular program that is the government's second-largest entitlement, helping to pay the medical bills for some 39 million elderly and disabled Americans, Medicare is expected to go broke in about a decade -- far sooner than Social Security and just before the nation's large baby-boom generation begins to become old enough to sign up. Even as the program hovers near insolvency, it also is widely regarded as antiquated, failing to pay for standard elements of contemporary health care, such as prescription drugs.

The central idea the commission has been debating, based on the proposal Breaux set forth two months ago, would tilt responsibility for Medicare away from government and toward the private sector. Until now, even as some elderly patients have chosen to receive care via private health maintenance organizations (HMOs), the federal government has determined the prices for the services Medicare covers and has paid much of the bills.

Under Breaux's proposal, dubbed "premium support," the government would, instead, give people money to help defray the expense of insurance premiums for private health plans, which they would buy on their own. The proposal had called for the government to give less money for wealthier patients, although Breaux abandoned that idea in recent days. His plan also would make patients wait longer to join Medicare, with the eligibility age rising gradually from 65 to 67.

Yesterday, Breaux and the commission's co-chairman, Rep. Bill Thomas (R-Calif.), released the most recent version of the commission's work and appeared -- even before today's vote -- to be preparing the groundwork for the next round: taking their proposal directly to Congress.

The document, Breaux contended, represents "good policy, as well as good politics." It has the support of all eight Republicans, but only one Democrat besides Breaux, Sen. Bob Kerrey (D-Neb.).

While not varying from Breaux's central ideas, the new version reflects the recent negotiations, which have focused primarily on two commissioners appointed by Clinton who have been regarded as the plan's most likely Democratic converts. In response to those appointees' belief that Medicare must begin paying for prescription drugs, the proposal now calls for the program to require that pharmaceutical benefits be an option for patients in both HMOs and in the traditional "fee-for-service" version of the program, in which people choose their own doctors and visit them whenever they want.

But the plan stops short of recommending that the government help patients pay for that medicine, as many Democrats want. Breaux said no subsidy was recommended because "there was not a meeting of the minds as to what size subsidy" could win additional Democratic support, without jeopardizing votes of the commission's Republicans.

Nor does the revised plan address the other issue at the heart of the recent haggling: Whether Congress should, as Clinton wants, set aside substantial amounts of future federal budget surpluses to keep the program solvent longer.

In his State of the Union address, the president proposed devoting to Medicare 15 percent of the anticipated surpluses over the next 15 years -- a total of nearly $700 billion. The idea has been condemned by Republicans, who would rather use that money for a tax cut. And it was criticized last week by both the General Accounting Office and the Congressional Budget Office, which said that strategy would be conterproductive, unwisely lifting some of the sense of urgency for making difficult but needed reforms. Breaux called the GAO critique "particularly devastating."

Even lacking what both Breaux and Thomas called "the super-supermajority" of 11 votes required by Congress, they insisted the commission's work had not been in vain. "This proposal deserves to be law," Thomas said. "And it deserves to be law before the 2000 election."