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The Medicare chicken game: Only the elderly are likely to lose


WASHINGTON -- President Clinton and Republican leaders in Congress are playing chicken on Medicare. One result is likely to be something less than a long-term solution to the serious problem of providing health care for the elderly.

And another result may be further reinforcement of voters' skepticism -- or cynicism -- about the ability of the political system to deal with anything more complicated than proclamations of national peanut week.

DTC There is no mystery about why there is so much suspicion on both sides about the Medicare issue. Other than the basic Social Security benefit question, no issue has such political volatility. And there already has been ample demagoguery on both sides, particularly during the 1996 election campaign.

In their dealings on the budget in 1995 and 1996, the Republicans made a classic political blunder in proposing reductions in the growth of Medicare spending roughly equivalent to tax reductions they wanted to grant to middle- and upper-income taxpayers.

Cuts that aren't cuts

They insisted that these were not cuts, because total Medicare spending would rise. But it would rise to a much lower total under the Republican plan than under existing law, making it easy for the Democrats to depict them as penalizing old folks while paying off the fat cats. The Democrats' charge that the Republicans wanted to "cut" Medicare benefits clearly had political sting throughout the campaign.

The Republicans now are not quietly accepting President Clinton's proposals for "savings" of $158 billion in Medicare costs over the next five years. Why, they are asking, were they "cuts" when we wanted to make them and "savings" when proposed by Mr. Clinton?

Goring the other ox

There is, of course, a White House answer. The proposal would realize its savings by reducing payments to medical providers, not by reducing benefits for Medicare beneficiaries or increasing the premiums they pay for full Medicare coverage.

That, however, is the rub. The Clinton proposal looks like a short-term fix for the immediate situation rather than a basic restructuring of the system that will assure its long-term viability. The chicken game centers on who, if anyone, will propose such a fundamental change in the plan.

In other politically volatile situations, the opposing parties have copped out by establishing bipartisan commissions so the blame would be shared in the eyes of the voters. By such a formula President Ronald Reagan and Democratic leaders of Congress "saved" the Social Security system in the early 1980s. It is also the approach that has been used with some success in closing military bases.

This time, however, the Medicare issue is being confronted as part of the attempt to balance the federal budget by 2002. And you can't use some commission to write a budget -- even if the first political imperative is to share the blame.

Something to ease the pain

So the pressure is most intense to find a compromise under which neither side can blame the other in the 1998 congressional elections. And that pressure means, in turn, there will be a great temptation to make the whole thing as painless as possible.

Meanwhile, the president and the Republican leaders are directly opposed on the balanced-budget amendment. And Mr. Clinton did not warm the climate for bipartisanship by suggesting in his State of the Union address that such an amendment might threaten Social Security benefits.

At the moment, the president holds the upper hand. Opinion polls show him with approval ratings over 60 percent while those for the Republicans in Congress, still on the defensive since they shut down the government in the last major budget negotiation, are below 40 percent.

This means Mr. Clinton might be in a position to take the lead in coming to grips with the issue. But there is no sign that he is willing to spend his political capital to do so.

Jack W. Germond and Jules Witcover report from The Sun's Washington bureau.

Pub Date: 2/12/97

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