Democrats joined with Republicans in the U.S. Senate Monday afternoon to make virtually certain the first major reforms in the Medicare program since it was created in 1965. The bipartisanship suggests that changes, while arguably improvable, begin a necessary new phase in the health insurance program for elderly citizens.
Prescription drug coverage beginning in 2006 is the most-discussed feature in the bill agreed to by a House-Senate conference committee. It passed the U.S. House 215-210 as dawn broke Saturday morning over Washington. The vote was held open for two hours to allow last-minute arm-twisting by the leadership.
Senators, rushing to complete a heavy calendar of controversial legislation before a holiday recess in December, voted in early afternoon by a 70-29 margin to end a Democrat-led filibuster. Sixty votes were required for cloture.
The Medicare bill, if approved as expected after other delaying tactics, would begin the prescription drug option in 2006, with discount cards to be issued next year for use in the interim.
In addition, in 2010 and afterward, government-run Medicare would be required to compete against private health care options in selected metropolitan areas, but those would be experimental prototypes, and no one would lose coverage.
Some liberal Democrats, led by the oratorical fire of Sen. Edward Kennedy of Massachusetts, warned that the reforms marked the beginning of Medicare's privatization, soon to be followed by the dissolution of Social Security. Their words weren't persuasive.
As the old dictum of politics instructs, “Follow the money,” and in so doing find the changes in the Medicare bill.
About $125 billion during the next decade, according to published reports, would go to the health care industry for increased payments. Add higher subsidies for private employers who provide coverage for retirees.
Critics of the reforms contend the higher payments will cause the program to run out of money sooner than forecast. A rosier outlook might hold that Congress would be required to provide the elusive, permanent financial fix for Medicare sooner rather than later with more spending committed to the program.
Supporters of the health industry subsidies also said it would help keep some professionals in practice because, otherwise, they could not make enough money.
Additional money for companies in support of private retiree programs would encourage them to keep retirees on their coverage plans, especially for prescription drugs. Rural hospitals would get about $24 billion over the next decade.
All things considered, the bipartisanship with which the bill reached the point of passage indicates a strong measure of optimism for outcomes. It has been long in the making, difficult in the negotiating.
If it does not work, it is a political certainty that it will be back on the table and the floor of both houses of Congress. It is worth a try because the program is inadequate as it is structured.
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