President Clinton addresses reporters at the White House on Tuesday. (Reuters) Related Links Medicare Panel in Policy Deadlock (Washington Post, March 16) Breaux Aims to Cultivate Medicare Reform (Washington Post, March 14) Medicine Costs Spur Medicare Battle (Washington Post, March 14)

By Amy Goldstein and John F. Harris
Washington Post Staff Writers
Wednesday, March 17, 1999; Page A2

The future of the faltering Medicare system landed back squarely in the fractious realm of politics yesterday, as a federal commission that was supposed to guide reforms of the program disbanded in dissent, unable to agree on any advice for Congress and the White House.

Leading congressional Republicans immediately joined the panel's chairman, Sen. John Breaux (D-La.), in calling for Congress to act this year to give private health plans greater control over the nation's health insurance program for the elderly. And they lost no time in accusing the White House of blocking the road to reform.

Mindful that he lacked the necessary votes, Breaux nevertheless vowed at the start of the panel's final meeting: "I'm going to keep working on this issue as long as I'm in Congress. . . . What we have today is not a defeat, but the beginning of a process that will lead to true, serious reform."

But even before the commission convened, President Clinton was trying yesterday to claim the high ground on Medicare reform for himself. He said the commission had done "valuable work" but that the approach it considered "falls short in several respects." He promised to issue his own map for reforming Medicare, possibly as early as next month, but was sketchy about what it would entail.

The commission's deadlock and the swift partisan positioning cast further doubt on whether the federal government has any realistic possibility of deciding before the next presidential election on a way to shore up Medicare. The program is expected to run out of money in about a decade and is widely considered to be antiquated in the services it covers.

Given the large stakes--the program helps provide medical care to the nation's 39 million elderly and disabled Americans--partisans on all sides lost no time in trying to pin blame for the commission's disappointing finish. After an impassioned two-hour airing of each member's views, the commission supported Breaux's proposal on a vote of 10 to 7, which was one vote short of the number required by law to formally deliver any advice.

Without impetus from the bipartisan commission, composed of members of Congress and health policy experts, "you are deceiving yourself to say [the odds of rapid reform] aren't steeper now," said Sen. Phil Gramm (R-Tex.), who voted for the plan. "But it isn't impossible."

Under the central feature of Breaux's plan, the government no longer would pay patients' bills directly or set prices for the services that Medicare covers. Instead, it would give patients money to help them pay insurance premiums, either for private HMOs or the traditional "fee for service" version of the program.

As the members took turns explaining why they would support or reject that plan, it became plain that the deep philosophical differences that divided members when they first convened had not narrowed after a year of work.

The commission's conservatives said that the private marketplace could give Medicare patients a broader choice of health care and better services, while saving the government money. Liberals argued that such an arrangement ultimately could cost patients more money and that the expected savings would prove illusory.

In addition, members disagreed on how far Medicare should go to make it easier for patients to afford prescription drugs, for which the program does not pay. And they split over whether the government should--as Clinton has suggested and Breaux has resisted--try to keep the program solvent longer by promising it money from expected federal budget surpluses.

Laura D'Andrea Tyson, one of two Clinton appointees to the commission who had been considered a swing vote, said that Breaux's approach would make Medicare more efficient, but wouldn't produce enough savings to correct the program's financial problems. "This proposal ducks it. It doesn't address where the money is coming from," Tyson said.

But Sen. Bob Kerrey (Neb.), the only Democrat besides Breaux to endorse the plan, said the approach would be helpful at a time when neither politicians nor the public have shown willingness to make cuts in the program--and when the large baby boom generation is nearing retirement age.

Such colliding views are why Medicare reform is almost certain to remain difficult. "There are philosophical differences, equity concerns, fiscal concerns, enormous political considerations that are a part of this," said Thomas Mann, director of governmental studies at the Brookings Institution.

Breaux, and many Republicans on Capitol Hill, have started to argue that Clinton has made consensus harder by proposing to give the program 15 percent of budget surpluses over the next 15 years, but not encouraging Democratic commissioners to endorse the senator's plan. Republicans, in particular, contended that the president was subtly working to obstruct reforms before the 2000 election, because Medicare has proven to be a highly useful issue for Democratic candidates.

For a president who has defined Medicare reform as a major goal, Clinton's decision not to encourage Democratic commissioners to support Breaux's proposal was "a smart political move and a hypocritical policy move," said Robert L. Laszewski, a Washington-based health policy consultant.

Yesterday, the chairmen of the Senate Finance Committee and the House Ways and Means Committee said they would schedule hearings on Breaux's proposal.

Clinton vowed to do his "dead-level best" to secure reforms this year. Aides said Clinton's proposal was being drafted in consultation with congressional Democrats.

In addition to calling for use of the surpluses, Clinton has said he wants to give Medicare patients more help in buying medicine than the commission considered, although he has not said how the government would pay for it. And he wants to allow people as young as 55 to buy into the program. Even with that innovation, it is unclear whether Clinton would support Breaux's idea of raising the eligibility age from 65 to 67.