Feb. 2, 2001 (Washington) -- What does the healthcare crystal ball show for legislative action this year? Last year brought lots of talk about change, but little action in Congress, so will the gridlock break?
Republicans control the White House and both houses of Congress, albeit by very tight margins. And compared with President Clinton, Bush is not a huge health policy fan.
According to pollster Bob Blendon, PhD, no single healthcare issue dominated voters' concerns in November, with most favoring incremental steps in Medicare reform, managed care regulation, and helping the uninsured. Healthcare, he says, is an important, but second-tier issue.
That said, a Medicare prescription drug benefit is especially prime for action, pundits agreed at a health conference this week. Within his first two weeks at the White House, President Bush already proposed to Congress a $48 billion four-year temporary plan, termed "immediate helping hand," that would involve grants to states to run drug subsidy programs for low-income seniors.
Exactly what kind of drug plan might pass the tightly divided Congress isn't too clear. Lawmakers have greeted the Bush proposal with a lack of enthusiasm, especially Democrats who want a benefit that would be available to all seniors and would operate as a central Medicare benefit.
According to Republican pollster Bill McInturff, covering drugs for seniors is "the No. 1 health issue" this year.
Robert Reischauer, PhD, the executive director of the public policy organization Urban Institute, agrees. "Some action is almost inevitable on Medicare" by 2002. If not, he says, "then Democrats will have been handed a huge club" with which to beat up Republicans in the 2002 congressional elections.
McInturff says that some Republican leaders on Capitol Hill believe that drug coverage should be passed along with the structural reforms of Medicare -- instead of separately -- to move the program in the direction of privatization.
But Sen. Jay Rockefeller, (D-W.Va.), argues that large-scale Medicare reform will not happen in the near future, saying the two political parties have such fundamental differences in philosophy.
With that dynamic in play, McInturff warns, Republicans may face disastrous 2002 congressional elections if they fail to pass a simple drug bill.
The Medicare population will nearly double in the next 30 years, to 77 million beneficiaries, while the program's spending will skyrocket as a proportion of the nation's gross domestic product.
But right now, all that seems very far away. Medicare's financial stability is at an all-time high, measured by the statistic that the program isn't projected to go broke until 2024.
Moreover, Medicare's baby steps toward the free market have been more like stumbles. Robert Berenson, MD, who ran the Medicare+Choice program of HMOs for President Clinton, says that HMO enrollment has fallen significantly.