Now that the shameless campaign rhetoric has ended, it's time to begin the important business of governing.
When last we left the Bill and Newt show, President Clinton was skillfully torpedoing House Speaker Gingrich's ambitious plan to balance the budget and cut taxes on the back of the Medicare and Medicaid programs. Slow Medicare spending by $270 billion over seven years, Newt and the congressional Republicans originally proposed. The GOP later sought $168 billion in reductions, while the administration countered with a $124 billion package of cutbacks.
Then partisan squabbles and politics took over. But with the re-election safely in hand, the president's healthcare advisers now hint the administration may propose provider spending constraints of about $100 billion over six years.
Despite the staggering dollar figures involved in the proposed reductions, beating up on providers offers only a short-term fix for the Medicare monster.
With no more campaigns facing the crafty politician from Arkansas, Clinton has a golden opportunity to showcase his statesman credentials. If he were to flex his leadership muscles during the second term, a possible plan of action on healthcare could include:
Investing a sizable chunk of the upcoming inauguration speech outlining the healthcare challenge. In no uncertain terms, the president should focus on the precarious condition of the Medicare Part A trust fund, which ran its largest deficit ever in fiscal 1996. Without a viable plan, the trust fund could go bankrupt by 2001.
Outlining the need and rationale for politically unpopular moves such as raising the Medicare-eligible age to 67, higher copayments/deductibles for beneficiaries and means testing for wealthy seniors.
Continuing to push for creation of a federal healthcare commission, which would recommend a package of reforms for serious consideration by Congress and the administration. This effort has to be viewed as urgent and meaningful.
Supporting a new system of reimbursement that would steer Medicare patients to provider networks demonstrating the best value and greatest efficiencies. A combination of price and quality outcomes would determine the panel of authorized providers.
A public relations campaign designed to educate Americans about how Medicare works and why it should be viewed as a defined contribution program, rather than an open-ended entitlement.
Clinton is a smart man who values his place in history. With healthcare reform, he knows the political consequences of doing the right thing. We suggest he take that risk.