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A Pass on Medicare

Friday, January 22, 1999; Page A34

THE POSITION the president took on Medicare in his State of the Union address was all dessert, no spinach. In that sense, it was emblematic of much else about the speech -- a call to benefits, with costs deferred.

The Medicare problem is, if anything, larger than the Social Security problem on which the president focused Tuesday night. That's because it has to do not just with the cost of health care but with the containment of that cost. How to create a system that will deliver adequate health care yet be affordable? That is the question.

Mr. Clinton proposed assigning about a sixth of the projected budget surplus over the next 15 years to Medicare. If current estimates are right -- a big if -- that would amount to about $700 billion. The effect would be to buy time. Instead of being exhausted around the year 2010, the Medicare trust fund would last until about 2020. That would be a temporary but not a trivial accomplishment. The proposal could also have the useful political effect of helping to deter an improvident tax cut. Do Republicans really want to use the surplus for a tax cut at Medicare's expense? That becomes part of the frame of the argument.

But the president then proceeded to compound the problem he had moved to ease by suggesting that a prescription drug benefit could be added to Medicare. A drug benefit is a good idea -- the right social policy -- but precisely because drugs are so costly. It would make more expensive a program whose projected costs already exceed its dedicated revenues.

The president, in his effort only to please, said not a word about how in the long run that gap between cost and revenue might be closed. We don't mean he needed to lay out an elaborate plan. But a reminder that a day of reckoning lay ahead? An acknowledgment that the proffered drug benefit will have a price, in the form of higher taxes or lesser benefits or savings elsewhere in the budget? He said none of that. The Medicare problem lies over that bridge to the 21st century.

© Copyright 1999 The Washington Post Company

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