There's a season for everything.
The Friday after Thanksgiving, for example, marks the traditional kickoff of the Christmas shopping season, when companies break out their best ads and new sales pitches. The release last week of the report from the trustees of the Medicare Part A trust fund marks the traditional start of the Medicare demagoguery season, when both political parties trot out their attack strategies.
And it is almost certain that with the election just five months away, this year will bring a particularly mean season of partisan finger-pointing, sniping and, above all else, inaction.
Last year, the Republicans in Congress seized upon the release of the trustees' report, which showed that the trust fund would go broke in 2002, as justification for their balanced-budget plan that would have reduced projected Medicare spending by $270 billion over seven years.
It was a brilliant operation and led to some of the Republicans' best moments during the balanced-budget debate. The trust fund was a tangible thing that the public could understand. It was going broke. Over and over again, the Republicans used the analogy of the family checkbook, and people seemed to understand it. While GOP leaders focused on the poor health of the trust fund, they had the Clinton administration on its heels.
Problems developed, however, when the White House started attacking the GOP plan as too much, too fast. GOP leaders abandoned the trust fund argument and tried to explain the intricacies of their proposal with very little success.
This year, Republicans say they don't intend to repeat their mistake. GOP leaders have rightly been attacking the White House for weeks because last Wednesday's release of the trustees' report came more than two months after it was statutorily due.
Several White House and HCFA press aides told me with a straight face that the report was delayed because of last winter's snowstorms and the federal government shutdowns caused by the budget impasse (A glorious bit of Washington circular reasoning since the impasse was at least partially caused by the haggling over the state of the Medicare trust fund).
What really happened, according to a number of Democrats, is that the trustees, knowing that the report was going to be red meat to GOP leaders, were looking for ways to sanitize the language of the report to make sure it had as little taste as possible.
But the fact is the contents of the report are of almost no consequence (for the record, the trust fund is going broke faster than previously estimated and in fact is already taking in less than it is paying out).
Republicans will once again hold up the poor financial condition of the trust fund as justification for their balanced-budget plan. Democrats again will say that they, too, are worried about the trust fund but that its condition is not as bad as the Republicans would have you think. Both sides already have their political advertising campaigns ready to go, and it won't be long before the airwaves are filled with commercials featuring scared old people shuffling in and out of hospitals.
The problem is, all that doesn't add one day to the life of the trust fund. The American Hospital Association has begun an ad campaign of its own in Washington, touting an independent Medicare commission. Under the AHA plan, the commission would take the federal Medicare budget each year and translate it into a benefits package that would ensure that the budget was met.
Presumptive Republican presidential nominee Bob Dole also has an idea for a commission, but it is different from the AHA's. Dole's commission would be a one-time panel that would look at long-term solutions to the trust fund problem similar to the commission headed by Alan Greenspan that looked at the Social Security system in the early 1980s.
Either commission might help take the politics out of the issue and allow lawmakers to join hands and jump off the Medicare cliff together.
At a recent conference sponsored by the AHA and the nonpartisan Alliance for Health Reform, health policymakers said that last year's stalemate over Medicare and Medicaid had not really cost the reform movement anything.
That cannot be further from the truth. Last year took its toll on the courage of lawmakers. Republicans and conservative Democrats who were battered for seeking Medicare and Medicaid reforms have been far more timid this year than last. In fact, the way GOP leaders have this year's budget bills scheduled, no vote on Medicare will even occur unless Medicaid and welfare reforms are first enacted, which is about as likely as me finishing my Christmas shopping in June.
It's clear from a pair of letters by House and Senate Budget Committee staff leaked earlier this year that GOP leaders now consider Medicare and Medicaid areas to be tiptoed around rather than attacked head-on.
"It will be necessary to think very politically" about the budget, said a Senate Budget Committee memo echoing a similar sentiment in a House memo.
All that adds up to is another wasted year. At this time next year, the 1997 version of the Medicare Part A trust fund trustees' report will be released.
There is little reason to believe the trust fund will have magically healed itself. By then, the projections may say that the trust fund will reach a zero balance in 2000. That would very nearly bring the life of the trust fund into balance with the two-year time frame that marks the political horizon for Washington lawmakers.
Maybe then lawmakers can finally go shopping for a real solution.