Healthcare reform made a surprise appearance, if only a superficial one, in the presidential and vice presidential debates.
As expected, President Clinton and Republican challenger Bob Dole used their differences on the failed Republican Medicare-reform proposal of 1995 and Clinton's failed comprehensive healthcare reform package of 1993 to define the differences between themselves as the Nov. 5 election nears.
But both candidates agreed that a bipartisan commission is the best way to pursue long-term Medicare reforms as the system prepares to pay for the healthcare of the baby-boom generation.
In addition, both candidates backed some sort of incremental healthcare reforms next year to tighten the health insurance safety net. Dole, who has positioned himself as the tax-cutting small-government candidate, even suggested expanding Medicaid.
"Obviously, it's incremental," said Jack Bresch, government liaison with the Catholic Health Association, of Dole's suggestion. "However, incremental is the way we're going to do it for the foreseeable future."
To expand coverage for the uninsured, Clinton touted a $2 billion-a-year plan he included in his fiscal 1997 budget proposal. That plan would subsidize health insurance premiums for up to six months for temporarily unemployed workers.
Dole, meanwhile, also held out the possibility that his $550 billion tax-cut plan could include incentives for uninsured people to purchase health insurance.
"I would think that would get pretty costly pretty quickly if people take it and it's successful," said Sherry Hayes, vice president of InterHealth, a largely Protestant healthcare organization.
Some provider group representatives, however, drew hope from the debate that expanding health insurance coverage might be on the agenda of the next administration no matter who is elected.
"If both candidates for president would have an agenda to address it, we would get it done no matter who is elected president," Bresch said.
But others were less optimistic, saying increasing coverage was not included in either candidate's opening or closing remarks and therefore is not a high priority.
"If you look at the front end and back end of either candidate's points, (expanded coverage) was not in there," said American Hospital Association President Richard Davidson.
The Clinton-Dole debate, along with the debate later last week between their running mates, Vice President Al Gore and GOP vice presidential nominee Jack Kemp, also spotlighted an emerging consensus for a bipartisan commission to examine long-term structural reforms to Medicare to prepare it for the baby boomers. That generation will start collecting benefits in 2010.
HHS Secretary Donna Shalala, speaking to reporters last week, said administration officials would give Clinton, if he is re-elected, an outline of how a commission might operate after the election.
In addition, she said Congress and the White House are likely to agree to about $100 billion in short-term savings from Medicare provider payments. She said such savings could extend by a decade the life of the Medicare Hospital Insurance Trust Fund, which is now projected to be exhausted in 2001.
Shalala did not identify specific payment cuts, but characterized them as "the usual suspects." She added: "I don't think anything on the list will be a surprise."