What Bush has proposed is an "Immediate Helping Hand" program for poor seniors to help them buy prescription drugs. The $46-billion dollar plan would be administered by the states as a stopgap until more comprehensive Medicare reforms are passed. For that, Bush is suggesting a 10-year, $153-billion overhaul that would revamp the system to make it more competitive with the private marketplace.
Even so, Reischauer says the transition will be difficult. "In a way, we've promised more than we can deliver, and one aspect of the promise is the extent to which low-income people would be subsidized. ... It's expensive is what it is. If you ask me, what you get is a pretty chintzy benefit," he says.
Also during his first 100 days, Bush also unveiled a proposal to provide tax credits to help low-income people buy insurance. The benefit would be $1,000 for individuals and $2,000 for couples, which the administration says would cover 6 million more people. But Reinhardt argues more needs to be done to assist the 40-million-plus Americans who still have no coverage.
In fact, Reinhardt says the Bush administration, like it or not, will have to expand existing entitlement programs.
"They will hate to do this, but eventually Republicans always do things they hate. After all, who put in administered prices, which is really a Soviet-style kind of price determination? Reagan, with the Medicare fee schedule," says Reinhardt.
So far the Bush team has not committed itself to the controversial issue of federal funding for fetal stem cell research. The technology offers hope for treating dozens of chronic diseases but requires the use of tissue derived from human embryos.
"There's a lot of conservative Republicans who have family members with diseases [that would use] treatments that could be discovered using stem cells," says Reischauer.
Both Reischauer and Reinhardt agree that judgement must wait until the Bush healthcare team is in place. That includes Tom Scully, the nominee to head the much maligned Health Care Financing Administration -- in effect the government's administrator for Medicare and Medicaid.
In addition, Mark McClellan, MD, PhD, a highly regarded Stanford University economist, is advising the White House on Medicare and related issues. McClellan is the former CEO of the Federation of American Hospitals.