X

The Great Medicare Debate Of 1995 . . Sort Of

(Newt - Would you buy a used promise from this man?) Gingrich:"Think about a party whose last stand is to frighten 85-year-olds, and you'll underst

(Newt - Would you buy a used promise from this man?)

Gingrich:"Think about a party whose last stand is to frighten 85-year-olds, and you'll understand how totally morally bankrupt the modern Democratic Party is,"

Oh?

In case you forgot - the Republicans did try their hand at Health Care reform in 1995. Then it was Medicare and the intention was to gut it, although they (as always) offered no details. They were quick to lob fear into the monologue - as they seem so willing to do at every opportunity.

Below is a summary (h/t Jon)

G.O.P. ANNOUNCES PLAN TO OVERHAUL MEDICARE SYSTEM

By ROBERT PEAR

Published: Friday, September 15, 1995

House Republican leaders unveiled their proposal to redesign Medicare today,

but it was surprisingly short on details and had none of the expected

financial incentives for elderly people to join health maintenance

organizations or other private health plans.

The package is supposed to cut projected Medicare spending by $270 billion,

or 14 percent, over the next seven years, and Republicans had hoped to

achieve much of the savings through greater use of H.M.O.'s and other forms

of managed care.

They said affluent beneficiaries should pay much higher premiums, but they

acknowledged that they were still struggling to achieve the savings they

need to meet their self-imposed goal.

In deciding not to offer financial incentives for joining H.M.O.'s, the Republicans said they feared that such incentives would make them vulnerable to charges of crass commercialism. But they predicted that elderly people would voluntarily join H.M.O.'s to get coverage for prescription drugs and other goods and services not covered by the standard Medicare program.

As Republicans scrambled to flesh out their plan, it was clear that many important decisions had yet to be made. They issued a brief summary of their bill, the Medicare Preservation Act of 1995, with a series of questions and answers. But there was no precise breakdown of how they would meet their goal.

Speaker Newt Gingrich provided some details at a four-hour party caucus. He opened the session with a blistering speech attacking President Clinton.

"Think about a party whose last stand is to frighten 85-year-olds, and you'll understand how totally morally bankrupt the modern Democratic Party is," Mr. Gingrich said at the caucus, a rare joint meeting of House and Senate Republicans. The Senators stayed for one hour.

Democrats reacted with fury and anger, saying the Republican proposals would increase costs for Medicare beneficiaries and damage the quality of their health care. They said the Republicans were hiding crucial details of their Medicare proposals and intended to ram the legislation through Congress before people understood it.

Republicans said they were determined not to repeat the tactical mistakes that President Clinton made in trying to redesign the nation's health care system in 1993 and 1994. But the delays in the development of the Republican plan, the confusion over cost estimates, the daily disclosure of new details and the hasty revisions made in response to political pressures were eerily reminiscent of the problems that bedeviled Mr. Clinton.

The Republicans start from a stronger political position than President Clinton, and they have displayed much greater party discipline than Congressional Democrats showed last year. But the Republicans face a formidable challenge because the Democrats have vowed an all-out effort to resist their Medicare proposals and see the battle as an opportunity to establish themselves as champions of the elderly.

In outlining their proposals, Republicans said they had decided to spare beneficiaries while curbing Medicare payments to doctors and hospitals. But Representative Henry A. Waxman, Democrat of California, predicted that such cutbacks "will destroy Medicare in a few short years" because many doctors will decide not to take Medicare patients at the lower payment rates.

For their part, Republicans said they were modernizing Medicare to prevent its Hospital Insurance Trust Fund from going bankrupt. Democrats said increasing Medicare premiums would do nothing to help the hospital trust fund because the premiums do not go into that trust fund.

Representative Sander M. Levin, Democrat of Michigan, said the Republican plan was vague. "It says little, and much of what it says is untrue," he said.

Moderate Democrats said they were also disappointed, for somewhat different reasons. Senator Joseph I. Lieberman, Democrat of Connecticut, said, "The Republicans are proving remarkably timid."

David B. Kendall, a health care analyst at the Progressive Policy Institute, a research center for moderate Democrats, said: "The Republicans have blinked. They seem to have given up on the idea of restructuring Medicare."

The heart of the Republican bill is a proposal to let Medicare beneficiaries enroll in all sorts of private health plans, including H.M.O.'s, but it does not give them strong financial incentives to do so. The purpose, as described by Mr. Gingrich and Bob Dole, the Senate Republican leader, is to inject free-market forces into the Medicare program to save money and increase beneficiaries' options.

But House Republicans seem to have retreated on an important issue: Representative Bill Thomas, chairman of the Ways and Means Subcommittee on Health, said that private health plans would not compete on the basis of price.

The Government would make a fixed payment to any private health plan chosen by a Medicare beneficiary. Under the Republicans' earlier proposals, Medicare beneficiaries who chose low-cost health plans would have received rebates for the difference between the premium and the Federal payment. But Mr. Thomas said the Republicans no longer intended to allow such rebates. H.M.O.'s and other health plans could compete by offering additional benefits, but they could not compete on the basis of price, he said. Representative James C. Greenwood, Republican of Pennsylvania, said: "We want seniors to make choices based on what's good for their health care, not on the basis of getting a toaster or some other financial incentive. Rebates

should not enter into that decision." Ten percent of the 37 million Medicare beneficiaries are now in H.M.O.'s.

The Republicans proposed higher Medicare premiums for beneficiaries with incomes above certain levels: $75,000 a year for individuals, $150,000 for couples. For the most affluent beneficiaries, premiums would more than triple. The premium is now $46.10 a month.

Republicans said the premiums would increase by smaller amounts for less affluent beneficiaries. But Democrats said the Republicans had significantly understated the increases that would be required.

Republicans said they did not know how many additional people would join H.M.O.'s under their plan or how much money would be saved by managed care. So they are relying on a budgetary device known as a failsafe mechanism.

Under the proposal, the Secretary of Health and Human Services would reduce the scheduled increases in Medicare payments to health care providers like doctors and hospitals if they exceeded spending targets. Democrats said that looked like the price controls Republicans vehemently denounced as a feature of President Clinton's health plan.

After today's caucus, Representative Christopher Shays, a Connecticut Republican on the Budget Committee, said he did not have enough information to know if the proposal would save $270 billion.

Mr. Gingrich said that under current law, Medicare's hospital trust fund would run out of money in 2002, and he said Mr. Clinton had offered no plan to prevent that.

Photos: House Republicans yesterday outlined a plan to revamp Medicare in an effort ro save $270 billion over seven year. Bob Dole, the Senate majority leader, and House Speaker New Gingrich met lawmakers at a caucus. (Stephen Crowley/The New York Times) (pg. A1); The House minority leader, Richard A. Gephardt of Missouri, left, and the Senate minority leader, Tom Daschle of

South Dakota, were among the Democrats who criticized a Republican proposal, announced yesterday, for redesigning the Medicare system. (Stephen Crowley/The New York Times) (pg. A32) Chart: "REWORKING MEDICARE" Republicans issued a broad outline today of their plan to revise the Medicare system, but left the details sketchy. Here are the highlights:

Premiums: Calculated to rise slightly every year but to continue to account for 31.5 percent of Part B costs, which cover doctors' fees, rather than drop to 25 percent under current law. No increase in co-payments or deductibles. Means Testing: Affluent beneficiaries -- singles making more than $75,000 or couples making more than $150,000 -- would pay more, as much as triple the amount of current premiums, now $46.10 a month. Private Choices: Beneficiaries could choose to keep their current Medicare coverage or join private health plans, including health maintenance organizations. In return for a limited choice of physicians under a private plan, recipients could get added benefits like outpatient prescription drugs or eyeglasses.

Medical Savings Accounts: An option to all seniors in which they would get a high-deductible insurance policy along with a cash deposit in a Medical Savings Account that would cover a significant portion of the deductible. The policy would have no copayments, so that seniors would be assured a limit on their out-of-pocket costs. A person who used few medical services could get money back at the end of the year.

More C&L
Loading ...