by John M. Curtis
(310) 204-8700

Copyright December 29, 2002
All Rights Reserved.

ooking ahead to 2004, Republicans appear poised to tackle the thorny "health care" issue now that former heart surgeon Sen. Bill Frist (R-Tenn.) takes over as senate majority leader on January 6. Former president Bill Clinton and first lady Hillary Clinton practically upended the White House, pushing universal health care in 1994. With Frist's considerable health care background, policy wonks expect yet another attempt to overhaul a badly broken system leaving nearly 41.2 million Americans uninsured. "It's been almost 10 years since heath care was on the national agenda," said E. Richard Brown, director of UCLA's Center for Heath Care Policy Research, suggesting that health care might emerge as a lightening rod in 2004—but don't count on it. With Iraq boiling on the front burner and North Korea simmering on back, it's doubtful health care will steal the headlines.

      Hillary-Care failed in 1994 because it was bad medicine for the American economy, struggling to climb out of recession. Creating a single-payer government program scared many people, especially the insurance industry that fought the plan tooth and nail. Clinton tried to expand Medicare and Medicaid—the government's existing plans for seniors, the disabled and the poor—to all citizens, something which would have paralleled socialized medicine in Canada and Europe. Physicians—including the American Medical Association—supported the Clinton plan because it provided predictable reimbursement for medical services. Insurance companies and HMOs opposed the plan because it took private insurers out of the loop. With Frist now in charge, the White House will sponsor new health care legislation enabling private enterprise—namely, private insurers and HMOs—to seize control.

      During the 2000 campaign, prescription drugs for seniors occupied the debate. Former Vice President Al Gore proposed expanding Medicare to cover prescription drugs. Candidate Bush favored means testing, giving coverage to only seniors with proven financial need. Spiraling drug prices and health care costs give renewed urgency to developing some prescription drug plan for seniors. While a recent ABC/Washington Post poll showed that only 33% approved of Bush's handling of health care, it doesn't automatically mean that health care ranks high among respondents. Bush's chief political advisor Karl Rove signaled that the White House "would be aggressive and get things done," when it comes to health care, though priorities remain unclear. Even so, an expected war with Iraq, the ongoing war on terrorism and improvement of a flagging economy dominates national priorities.

      Controlling both house of congress, Republicans will try to change Medicare, though it's likely to face stiff opposition. Frist's original plan, endorsed by Bush in 2000, and co-authored with Sen. John Breaux (D-La.), favored transforming Medicare's current single payer, fee-for-service program into one that reimburses subscribers and insurers. Under the Frist-Breaux plan, Medicare would subsidize seniors directly to purchase private health insurance, not especially popular with physicians or patients. Bush's plan, to create tax-deductible medical savings accounts, also doesn't impress Democrats or moderate Republicans, believing still that Medicare's universal coverage should remain intact. Few people oppose greater government help to non-profit community health centers, though growing federal budget deficits place those programs in doubt. All in all, Bush and Frist's health care proposals face almost certain resistance.

      Putting more tax dollars into the hands of the HMO and insurance industry won't automatically guarantee access to better medical care. While something must be done about spiraling costs, HMOs have squandered Medicare tax dollars on expanding bureaucracies without improving access to health care. Frist's plan to restructure Medicare by giving seniors fixed sums to purchase private health insurance won't solve the problem of spiraling premium costs. Giving private citizens medical grants is a risky proposition, potentially driving up premiums. HMOs have long argued that fee-for-service—including the current Medicare system—promotes runaway prices. But HMOs also haven't produced the economy of scale and cost savings once promised, wasting tax dollars on growing bureaucracies. Pouring Medicare dollars into HMOs has already been tried and failed.

      Heading to Iraq, health care won't dominate the headlines in 2003. Nor is it likely to be Bush's Achilles Heal facing reelection in 2004. Overhauling Medicare carries far more risks to Republicans than quibbling about prescription drugs or pouring more dollars into community clinics. Before Frist gets off on the wrong foot, he must carefully reassess his relationship to the HMO industry or risk alienating colleagues on both sides of the aisle. Americans want more access to health care, but they don't want to trash the current fee-for-service Medicare system that has proven for the last 40-years—with all its flaws—to be the best quality, most reliable health care on the market. Seniors have already been disappointed by HMO Medicare plans that are either in disrepute or belly up. Regardless of party, seniors won't take kindly to tampering with the current Medicare system. Prescription drugs or not, Medicare is a trusted old friend.

About the Author

John M. Curtis writes politically neutral commentary analyzing spin in national and global news. He's a consultant and expert in strategic communication. He's author of Dodging The Bullet and Operation Charisma.

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