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Where is Bush's plan to reform Medicare?

By SARA FRITZ, Times Washington Bureau Chief

© St. Petersburg Times, published February 17, 2003

WASHINGTON -- Have you heard about the president who was surprised when Congress rejected his health care reform proposal because his advisers drafted it in secret?

This is a story about George W. Bush, not Bill Clinton.

Since the beginning of the year, White House officials have promised to unveil the president's proposal to reform the Medicare system and provide for prescription drug coverage. But the proposal was not outlined in Bush's State of the Union address and there are reports that it is being withheld because Republicans in Congress do not like it.

At a White House meeting on Feb. 5, Republican congressional leaders told Bush political adviser Karl Rove and Vice President Dick Cheney that while they hadn't seen the president's plan, they were mighty upset by what they had heard about it.

Republican leaders are particularly uneasy about Bush's desire to require seniors to submit to managed care in exchange for prescription drug coverage. And they are also angry they were not consulted while the Medicare proposal was being drafted at the White House.

House Speaker Dennis Hastert, R-Ill., said the president's proposal to put seniors into managed care programs cannot be accomplished "humanely." Senate Finance Committee Chairman Charles Grassley, R-Iowa, said the administration had botched the situation by drafting it in secret.

Even Senate Majority Leader Bill Frist, R-Tenn., also a physician, who was expected to work closely with the White House on a Medicare proposal, has said he will proceed with his own plan, no matter what Bush puts forward.

"I don't think the Senate needs a specific legislative proposal from the White House," Frist told reporters last Thursday after delivering a speech to a meeting of leaders of the AARP.

So it is now likely that the president will decide not to offer his proposal for revising Medicare, though he promised during the last two elections that this was a top priority item on his agenda.

In short, the Republicans face the same problem that undid the Clinton administration's proposal for reform: Health care costs are rising so rapidly, any improvement in care will require a change in the status quo, including some sacrifices by beneficiaries.

Meanwhile, Bush administration officials insist they are not pushing seniors into HMOs in exchange for prescription drug care. Tom Skully, the head of the Centers for Medicare and Medicaid Services, told reporters last week that "it's complete garbage that we're pushing people into managed care." But he didn't win over the skeptics.

Bush, in his State of the Union speech, also insisted that he would not force any seniors who like the current fee-for-service system to switch to managed care or anything else. What he didn't say is that seniors who choose to stay with the traditional Medicare system would not get prescription drug coverage.

The truth is that when candidates make promises, they always cross their fingers behind their backs. They usually don't know how they are going to fulfill their promises, but they assume some solution can be found.

Bush's effort to fulfill his campaign pledge to provide prescription drug coverage for Medicare recipients is two-fold: First, it likely would cost far more than the less than $400-billion the president wants to set aside for the program, and, second, Republicans cannot do it without making some voters angry.

This is why it's sometimes a mixed blessing for a single party to control both the Congress and the White House. To accomplish anything, it has to take credit for the good parts of a policy as well as the bad.

Right now, Republicans in Congress are not sure their sweeping electoral victory in last November's election has been as valuable to them as they had hoped. Now that they are in the majority, it seems President Bush has decided to take them for granted.

-- Sara Fritz can be reached by e-mail at and by telephone at 202-463-0576.

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