Jewish World Review June 24, 2003 / 24 Sivan, 5763
Peter A. Brown
Let seniors make their own choices
http://www.jewishworldreview.com | It would be a crime -- albeit a political one: theft of the future -- if Congress doesn't bring Medicare into the real world when it provides prescription-drug coverage.
In the world you and I inhabit, people evaluate trade-offs and make choices. Just because government is involved doesn't mean beneficiaries shouldn't have the same freedoms and responsibilities.
The Medicare issue reflects a split about the relative merits of free markets vs. government programs, and reality vs. political fantasy.
There is also the unfortunate but unavoidable component of political posturing. It is not Republican vs. Democrat. Think of it more as those intent on fixing Medicare's long-term problem vs. those seeking a political solution.
Most important, the dispute is over the reasonableness, given the huge Medicare costs a retiring baby-boom generation will impose, of giving beneficiaries even more benefits without getting anything from them in return.
Recipients paid for their coverage, which does not now include prescription drugs, through their working lives. The increasing costs and importance of prescription drugs make adding them to Medicare a good idea.
But it would also be smart not to bankrupt the system, which already faces difficult financial constraints, by providing that new coverage. Medicare's costs must be reduced - by raising the retirement age, reducing other benefits or structurally changing the program. If not, taxes must be raised.
The least painful approach would be giving beneficiaries a financial incentive to exchange their fee-for-service plan for managed care because of the savings that swap would produce.
Medicare is the primary health insurer for 40 million elderly and disabled citizens. Seniors vote early and often. Any politician with a brain is terrified of alienating them.
Thus their reluctance to tell our parents and grandparents: "We need to save money for future generations, and you need drug coverage. Let's make a deal. You'll be better off because you'll get coverage, and your grandkids will be better off because the system will be able to care for them when they need it."
President Bush's original plan was to provide seniors unwilling to convert to managed care something for nothing. They would get a bare-bones drug plan, infinitely better than the nonexistent one they have now. But his proposal sought very real financial incentives for people to choose a managed- care option.
That's as it should be.
When was the last time someone offered you something for nothing?
Only from government would a sane person expect a free lunch, which, of course, is what the critics are suggesting.
And when the president says managed care, he's talking about not just much-dissed health-maintenance organizations but also preferred-provider plans that offer choices of doctors and hospitals.
The array of choices is quite similar to those enjoyed by members of Congress and federal workers.
Yet, from listening to those opposed to Medicare reform, you'd think he was advocating euthanasia.
They fret about partial "privatization," of Medicare, which they consider only slightly more acceptable than the death penalty.
But insurers should be allowed to compete for business by providing managed-care policies that would be largely paid for by tax dollars.
The idea is to allow markets, incentives and choice to produce the competition that creates the needed economic efficiencies.
But worrying about the "integrity" of Medicare misses the point. The key is to protect the ability of the elderly and disabled - not just current recipients, but future ones, as well - to get medical care.
A government-run program does appear to be the answer, but it doesn't have to be ideologically pure. If injecting market forces into it makes it better able to deliver the product, that's a good thing.
Critics are fixated on guaranteed benefits, one-size-fits-all programs, and a belief that increasing the federal role - and costs - is preferable to any changes that use market mechanisms, even if they restrain costs without reducing the quality of service.
The critics have no plan, other than raising taxes, to deal with the increased costs coming when the number of Medicare beneficiaries explodes in the coming decades.
This is more than a fight about how to cover prescription drugs. It's more important than the political theater that it clearly has created.
It's about whether seniors should be able to make their own choices.
They're mature enough to handle that responsibility.
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