To some Democrats, the National Bipartisan Commission on the Future of Medicare has become just a gimmick to promote privatization of the Medicare program, which serves 39 million seniors and disabled people.
The commission's more liberal members think the commission's co-chairmen, Sen. John Breaux (D-La.) and Rep. William Thomas (R-Calif.), have not heeded calls to protect and modernize the traditionally fee-for-service program.
And that in turn may jeopardize any sense of bipartisanship in the commission's final report to Congress and the president, due this week. Republican backers of a plan to transform Medicare from a bill-payer to a contributor to seniors' private health insurance premiums were still a vote shy of a required supermajority late last week.
On the panel of nine Democrats and eight Republicans, at least three Democratic votes are needed to make "premium support" the panel's central recommendation. Under the 1997 law that created the commission, 11 votes are needed to pass along a recommendation.
The liberal Democrats point to a commission staff estimate showing that Breaux's premium-support plan will not extend the life of the Medicare Hospital Insurance Trust Fund, now projected to be exhausted by 2008.
Rep. Jim McDermott (D-Wash.), a commission member, cited similarities between Breaux's proposal and a Medicare reform plan that Republicans included in their failed balanced-budget legislation in 1995. McDermott characterized the plan by moderate Democrat Breaux as promoting Medicare "vouchers."
"The Republicans tried this voucher system in Congress and got whipped," McDermott said. "They decided they'd get this commission and try to finesse it, lay the groundwork and get it done this way. They haven't changed very much, (though) they've changed the packaging a bit," he said.
Although the commission staff estimated that Breaux's premium-support model would reduce Medicare costs between 16.3% and 38.6% by 2030, the change would not delay the hospital trust fund's insolvency date, because the savings would accumulate slowly.
The Congressional Budget Office, in a separate report, was silent on the issue of short-term insolvency and did not put a cost-savings estimate on the proposal. The budget office did say, however, that greater competition in the program could reduce short- and long-term costs.
HCFA actuaries, on the other hand, estimated savings of between $74.9 billion and $102 billion over the next 10 years simply because of the change to a premium-support model.
Meanwhile, short-term trust fund solvency has disappeared from the commission's debate, the Democrats contend. That's because advocates have trouble demonstrating savings from the premium-support proposal and because they do not want to discuss ways to increase revenues-including a politically unpopular tax increase, Democrats charge.
"That bothers me a lot," said Stuart Altman, one of President Clinton's commission appointees and a widely acknowledged swing vote on premium support. "I personally am not going to vote for a program that does not acknowledge that we've got to pay for whatever we design. We can't push that under the rug."
Thomas, for one, argues that solvency of the trust fund has become a meaningless issue since Congress and President Clinton agreed in 1997 to extend the fund's life from 2001 to 2008 by shifting $33.6 billion in home health costs from the trust fund into the general revenue stream over five years.
"The issue of (trust fund) solvency makes absolutely no sense whatsoever," Thomas said last week.
But others charge that the commission is going full-speed ahead on premium support because its Republican appointees are trying to help their allies in the health insurance industry.
"This was a single agenda from the very beginning," said a House Democratic aide, who asked not to be identified. "This is just a lobbying effort to get more bodies into private plans. But where does this save money?"
Among the GOP appointees is lobbyist Deborah Steelman, who is a registered lobbyist for Aetna U.S. Healthcare, Cigna HealthCare, the Pharmaceutical Research and Manufacturers of America, and Prudential HealthCare.
Breaux is also friendly with the health insurance industry. His 1998 re-election campaign received $101,000 from insurance political action committees in 1997 and 1998, including $6,000 from the national Blue Cross and Blue Shield Association and $3,000 from the Health Insurance Association of America, according to the Center for Responsive Politics, a Washington-based watchdog group. Thomas pulled in $87,500 from the insurance industry, including $10,000 from Blues plans and $8,023 from PacifiCare Health Systems, according to the center's data.
Breaux parried the charges that the commission leadership has not listened to Democratic members by saying that the traditional program will not be gutted under premium support.
"We're continuing a fee-for-service Medicare package that will be a viable option in areas where there's not a lot of competition" in health plans, Breaux told reporters last week.
Thomas, meanwhile, lashed back. "If (liberal Democrats) had another model, where is it?"