78, 76, 86.
Those are the three numbers that have Washington hospital lobbyists most worried right now. They're the amounts in billions of dollars that hospital Medicare spending would be reduced under the Clinton administration budget, the House Republican Medicare reform plan and the Senate Republican plan, respectively.
In the overall scheme of the federal budget, where a $10 billion difference is considered as significant as a cease-fire in Bosnia, the numbers are very close. In fact, it's hard to tell the differences between the plans-at least as they relate to Medicare Part A reductions-even with a score card.
For some time now, the fight by provider groups against $270 billion in Medicare spending reductions has been halfhearted, primarily because Republican leaders have been careful to keep just the right amount of sweeteners in the plan. By giving providers the ability to contract directly with Medicare and giving them sought-after provisions like antitrust relief and malpractice reform, House Speaker Newt Gingrich (R-Ga.) has made it impossible for provider groups to attack the plan without jeopardizing the gains they've made.
Providers also have been counting on what has come to be known in Washington as the "veto strategy." According to the theory, after House and Senate Republicans pass their reform plans for Medicare and Medicaid, President Clinton will veto the packages because the reductions are too harsh. And that's when the real negotiations will begin.
That's also where 78, 76 and 86 come in.
The problem is that even if Clinton is successful in negotiating down the total level of spending reductions, it's unlikely he would agree to lowering hospital reductions below the $78 billion in his own budget.
Clinton has been vocal in his opposition to adding costs to beneficiaries, so it's safe to assume he'll want to see the elimination of some of the extra beneficiary costs included in the GOP plans.
Furthermore, the lack of any real opposition from hospital groups to the spending reductions hasn't been lost on the White House. Chief of Staff Leon Panetta recently met with American Hospital Association officials and offered to work to lower the level of hospital cuts included in the budget if the AHA would attack the GOP plans. The AHA declined. The hospital industry can hardly expect the Clinton administration to fight for hospitals' interests when the industry won't fight for them itself.
That gives provider lobbyists precious little wiggle room and a lot of concern.
Someone once said the definition of a crazy person is someone who does the same thing over and over and expects a different outcome.
Last year, one of the reasons why the Democrats in Congress failed to pass a single healthcare reform plan was that they had so many healthcare reform plans to pass. By the time the entire operation had sunk under its own weight, there were no fewer than 10 Democratic plans, none of which had the support of a majority of Democrats.
The Republicans learned a valuable lesson from the Democrats. This year they have one Senate Medicare plan and one House Medicare plan. In the House, the two major committees with jurisdiction over Medicare are working off the same template, and few, if any, substantive changes are likely to be made by either of them.
No splinter groups. No rump groups. No mainstream coalitions. GOP leaders have worked to keep their dirty laundry behind closed doors. So far they've been successful in finding a middle ground between factions. Rifts like those between states with high HMO reimbursements and those with low reimbursements have been squelched through a combination of strong-arm tactics and Kissinger-like negotiations.
The Republicans have brought party unity back to Washington. While critics say the House and Senate leadership have too much control, it's clear that a ship cannot reach its destination without a strong captain.
But did Democrats learn the same lesson from their own mistakes?
The Democrats' best hope of having a real impact on the healthcare debate is to rally around a single plan and hope to pick off a few moderate Republicans.
Instead, there already are no fewer than five Democratic Medicare reform plans. Only the Senate Democratic leadership plan has any hope of garnering a majority of support from its members. That's because Democratic leaders have vowed to provider groups that they will keep anything controversial out of the package.
But even given that, the Senate plan isn't likely to bring every Democrat into the fold.
Who knows what will happen in the next election? Right now, it seems hard to believe that Republicans can anger enough voters to lose the House. But if they do, the Democrats will probably see it as a mandate to produce a healthcare reform plan or two. Or three. Or 10.
Thumbs down to the Association of American Physicians and Surgeons, the conservative group that's still pursuing White House adviser Ira Magaziner through the courts. This summer, U.S. attorney Eric Holder declined to charge Magaziner, the architect of the Clinton healthcare reform plan, with lying under oath during a reform-related legal battle. Enough is enough. Let's bury the White House Task Force once and for all.
Thumbs up to Rep. Jim McCrery (R-La.) for calling Democrats "ninnies" and "scaredy-cats" during a Ways and Means Committee meeting last week. McCrery's attack is just the kind of theater that makes Congress so popular with the American people. McCrery does lose points, however, for the lameness of the attack. "Ninnies" and "scaredy-cats"? Any kindergartner with a little imagination could do better than that.