Anyone who doesn't believe that Medicare has become a flat tire on the Republican reform bus need only have been at the American Hospital Association legislative conference in Washington earlier this month.
Those few GOP lawmakers who spoke at both last year's AHA conference and this year's gathering must have thought they wandered into the wrong hotel.
Last year, House Speaker Newt Gingrich (R-Ga.) breezed into the AHA convention fresh from the Republican sweep of Congress. With every pledge to "rethink Medicare from the ground up" and every promise to balance the budget, Gingrich received a standing ovation from the hospital executives in attendance.
This year was a different story.
Gingrich, who's been keeping a lower profile since polls showed his approval rating at an all-time low about two months ago, didn't attend the session because of a "scheduling conflict." Senate Majority Leader Bob Dole (R-Kan.) was campaigning elsewhere.
Tepid applause greeted Republicans who did speak (not including erstwhile presidential candidate Gen. Colin Powell, whose rousingly patriotic speech was pure magic). Such a lukewarm response usually is reserved for liberal Democrats who call for more regulation of providers.
Speakers learned early on that supporting provider-sponsored networks was far preferable to "rethinking Medicare." The subject of constraining the growth of Medicare and Medicaid was almost completely avoided.
During a question-and-answer period with members of Congress, a hospital administrator from Atlanta was heartily cheered when he stood up and told the panel, "Don't do tax cuts and put them on the backs of Medicare and Medicaid."
The most substantial applause given to any elected officeholder went to Sen. John Breaux (D-La.) when he challenged an assertion by Rep. Bill Thomas (R-Calif.) that the GOP was not "cutting" Medicare.
"Anytime increases don't keep up with costs, it's a cut," Breaux said.
Despite the differences from a year earlier, it's doubtful that there has been any real shift in the politics of the hospital executives. More likely, they are just mirroring a widespread trend.
As two pollsters told a meeting of AHA trustees, national polls show that Medicare has become a positive issue for the Democrats and a lead weight for the Republicans.
What is clear is that those attending the conference were sending a message, and it was a very different message than the one they sent last year.
One reason Republicans haven't been able to get their Medicare message out is that, for the most part, they lack effective advocates. They have been unable to counteract President Clinton's ability to seem empathetic about the plight of Medicare beneficiaries.
Probably the GOP's best asset is Tennessee Sen. Bill Frist, M.D., an accomplished heart and lung transplant surgeon who is a member of one of the most influential healthcare families in the country.
Frist's father, Thomas Frist Sr., M.D., founded Hospital Corporation of America and was inducted into the Health Care Health Hall of Fame in 1990.
Frist stands out in Congress for a number of reasons, not least because he knows firsthand about the issues he debates.
He is also sincere, eloquent and able to boil down a complex idea into simple terms for the public and his fellow members of Congress.
One of the featured segments at the recent AHA meeting was a congressional debate on Medicare and Medicaid. The Democrats on the panel included the always glib Rep. Fortney "Pete" Stark of California and Breaux, a moderate dealmaker.
Frist was easily the most effective and well-received Republican on the panel. He was applauded when he said that as a physician who ran a transplant center he believed that doctors and hospitals should be given more control of Medicare capitated payments.
He also made a strong case for the GOP reform plan when he warned the hospital executives that if changes weren't made to the system, Medicare reimbursements would be reduced year after year.
If the GOP could find a way to make Frist its point man on Medicare and Medicaid, it would go a long way toward convincing not only the public but other lawmakers.
There was word out of the White House recently that Clinton adviser Ira Magaziner has found a new calling.
Magaziner was the man in charge of the White House healthcare reform task force that produced the ill-fated Clinton administration healthcare reform plan.
Since then, Magaziner has been almost invisible, appearing in public only on those rare occasions when he defended himself in court against charges by a conservative physicians group that he lied under oath.
But with his legal troubles all dismissed, Magaziner has been put in charge of a White House project to increase foreign trade by reducing trade barriers.
At least this time Magaziner can't be criticized if he makes the finished product larger than anyone had ever envisioned.