Delay Won’t Save Medicare

Bipartisan agreement to reduce the rate of growth in Medicare spending has extended by some years the life of the Hospital Insurance Trust Fund, over which insolvency loomed. But Medicare’s basic structural problems, which can only worsen as tens of millions of baby boomers enroll in the program starting early in the coming century, remain to be addressed. Faced with this politically explosive challenge, President Clinton and Congress have typically responded with plans to set up a commission to ponder the economic and demographic issues and recommend reforms. To propose changes is not, of course, to set them on the road to acceptance. For all anyone knows, the new panel’s proposals could disappear into the same black hole of political neglect as a predecessor commission’s did in 1995.

The commission, to be chosen this fall, isn’t scheduled to report until the spring of 1999. That seems a needlessly long time, given the vast amount of study that has already been done on Medicare’s problems and prospects. Further, it pushes off to the eve of a presidential election year what are likely to be some highly controversial recommendations, not the best of times to look for courageous political leadership in making hard decisions.

At his press conference this week, Clinton tried to allay concerns about the timing of the commission’s report by suggesting that it might choose to make some interim recommendations for reform next year. We hope that indeed occurs, because a lot of the changes that must be made if Medicare is to survive without consuming ever more of the budget are self-evident. The sooner they are given the imprimatur of what will presumably be a high-class bipartisan commission, the sooner Congress and the White House might be prompted to act.

For example, Medicare last year lost an estimated $23 billion to fraud and waste, about $1 out of every $8 it spent. A competent commission should have little trouble agreeing on ways to remedy that scandalous drain.

It’s clear at the same time that more of Medicare’s costs are going to have to be shifted to beneficiaries, especially the better-off, as the Senate courageously has recommended. Would a commission’s endorsement of this and other politically sensitive reforms encourage Congress and the president to do what’s needed? The way to find out if the politicians are up to the job is by having the commission put them to the test, not delaying until 1999 but starting next year.