THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, October 10, 1995 TAG: 9510100008
SECTION: FRONT PAGE: A8 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 62 lines
It was Bismarck who advised people with weak stomachs against watching two things being made - sausage and laws. Medicare reform is about to enter the sausage-making phase.
Republicans in Congress and the White House have assailed each other but beneath the rhetoric there's room for a deal. Both sides would squeeze payments for Part A by $90 billion. Both sides would raise Part B premiums - the White House to $82 a month over seven years, the GOP to $92.
The GOP plan shamelessly incorporates many features of the Clintoncare plan it attacked and defeated last year. Something very like a cap on health-care spending is proposed. There will be incentives for joining managed-care networks where patients will not necessarily be able to choose a personal physician.
It's true that the GOP seeks to reduce federal outlays by three times as much as the minimalist White House proposal. It's goal is not improved health care but a lower deficit and a tax cut. The White House hoped there would be more hue and cry against cuts so deep. The results from a recent ABC/Washington Post poll does show that the public disapproves of the Republican plan by a 58 to 23 margin. But the big dogs haven't barked.
The AMA has said the Republican plan could spell the end of fee-for-service medicine. The AARP says GOP cuts are excessive, but has only now decided to actively lobby against the plan.
Yet Speaker Newt Gingrich has played a very shrewd carrot-and-stick game. He's asked seniors to accept a $53 billion increase in premiums in exchange for promises that deductibles and co-pays won't rise and a fee-for-service option will survive.
Doctors have not yet balked at the $110 billion squeeze on their reimbursements because they've been promised a cap on medical-malpractice awards, a relaxation of rules restricting self-referrals to doctor-owned labs and the opportunity to set up their own provider groups to compete with HMOs.
The GOP is also quietly assuring critics that $270 billion is only a first bid. When they get behind closed doors with the president, they'll settle for less. In between, there may be vetoes and attempts to override and lots of grand opera, but a grand compromise is possible.
In theory, somewhere between $90 billion and $270 billion there's room for a deal that patients and providers can live with. An acceptable final package ought to means-test benefits, encourage seniors to enter managed-care plans like the rest of the nation, and offer a wide array of options.
Possible pitfalls include a system that rewards cost-cutting over quality of care. Squeezing too hard also runs the risk of creating de facto rationing. Many doctors are already reluctant to take Medicare patients because treating them is not profitable. That state of affairs could get worse. What good is a choice of doctor if none will choose you as a patient?
The 33 million seniors who depend on Medicare, and the millions coming along behind them, can't afford to avert their eyes as this sausage is being made. Their future physical and financial well-being is going to depend on Washington getting the recipe right.
KEYWORDS: POLL by CNB