The Medicare Mess

Yesterday's government report that Medicare will go broke in 2001 should have been a wake-up call about America's looming heath care crisis. Instead it resulted in more politics as usual. Republicans blamed Clinton for not signing a balanced budget on their terms, while the Democrats once more accused the GOP of tryng to use Medicare cuts to pay for tax windfalls for the rich. Meanwhile, the Kennedy-Kassebaum bill -- which would prevent people from losing health care coverage if they lost their job or had a "pre-existing condition" -- remains mired on Capitol Hill.

How fixed, and how dangerous, is this political gridlock?
We talked with Pulitzer Prize-winning Washington Post political reporter Haynes Johnson, coauthor with David S. Broder of the recently-published "The System: The American Way of Politics at the Breaking Point" (Little, Brown), a detailed analysis of the failure of the Clinton administration's attempt to pass health care reform.

In your book, you write about how a similar government report last year about the collapse of the Medicare hospital trust fund became an instant political football. Is the new report just déjà vu all over again?

It's a perfect metaphor for the breakdown of our political system. This is the tenth time in the last generation that Medicare has been supposed to run out of funds by a certain date. Each time it gets more severe, and each time nothing is done to address the larger problem. Now you're seeing it in the atmosphere of a highly charged presidential campaign. If you watched the news and the talk shows on television last night, all you saw was both sides pointing fingers at each other.

Is the Medicare funding situation really that serious, or is there some crying wolf here?

Both sides have been demagoguing and crying wolf on Medicare, but the issue is totally serious. The rate at which the funds are disappearing is accelerating while costs are continuing to escalate. We have an aging population that is living longer and being sustained by the high cost of medical technology. We're also a nation riddled with a debt that we can't fight our way out of. It is exactly why health care reform remains the single, crucial overall issue, the only issue, that touches every single American, from birth to death. It's also one-seventh of the American economy. If we don't deal with it, every single American will be held hostage by its breakdown.

What can be done to fix it?

Both sides must immediately reach a balanced budget agreement to restrain costs across the board, including health care costs and some extra cost-cutting incentives in the Medicare program. Then we have to move towards universal health care. That means raising some taxes, and older citizens paying more for their health coverage. Everyone has to share in some sacrifice so that everyone can share in a system that works. That's why universal coverage is an essential goal, so that you and I don't wind up having to pay for people who fall through the cracks. And we can do it. That's the frustration, and the tragedy, of this story.

And you believe it could have been done three years ago.

Absolutely. When Clinton became president it was the best opportunity of the century. Democrats and Republicans across the spectrum agreed that something had to be done to restrain the rising costs, and to address the rising numbers of Americans who had no health care coverage, including those who were being "downsized" out of their jobs, and out of their health care coverage. But Clinton's plan was so complicated and the scare tactics and misinformation were so wild that the public supported doing nothing. Now they're paying the price. We're all paying the price. When we began writing the book three years ago, 37 million Americans had no health insurance. Today 43 million have no health insurance.

Apart from Clinton and the Republicans, you also fault the Democrats, who then controlled both houses of Congress, for the failure.

The Democrats were so ridden with their own jealousies and jurisdictional fights that they couldn't even bring a bill to the floor when they had the power to do it. And they failed, not just because they weren't entirely united around the approach to reform, but for the worst ignoble and petty reasons -- those little fiefdoms, the baronies of the Hill, the chairman and the subcommittee chairman were fighting over jurisdictional battles even as health care reform was going right down the tubes and they faced total extinction. But they were so arrogant and out of touch. They deserved to lose the Congress.

If Clinton wins in November, do you think he might try for health care reform one more time?

No. I don't expect any political figure in our time ever to take on the kind of all-encompassing, comprehensive design of a reform that affects everyone's life in this country. The lessons of his last failed attempt are clear: you can't do it unless you have total bipartisan cooperation in Washington, and consensus in the country. And that will not exist for the next president, whoever he is.

Has Clinton learned from the failure?

Yes, no question. When we sat down and talked to him, he told us, "I tried to do too much, too fast. I didn't appreciate the lightning rod and the criticism that Hillary's role would have. I should have reached out to the Republicans earlier. I should have made a speech to the country when it became clear to me after one year that we were not going to pass something -- I should have said 'Look, OK, it's not going to happen in a year or 100 days or whatever, but we're going to keep on with it and here's where we are.' I should have had closure with the country when it failed."
It was a remarkable confession. Never before, I believe, on any major issue, has a sitting president so admitted that he screwed up. Then he said, "I set the Congress up for failure and I set myself up for failure." That is breathtaking. Here's a sitting president who knew this book would come out before the election, and knows these words will be recycled against him. Yet he said them, and in this very analytical, clear, direct tone. He was a man not wringing his hands in Nixonian paranoia or Johnsonian rage at the forces readied against him and how unfair it all was.

"Sugar, I'm glad we're out of there."

-- Oliver Elders, to his wife Jocelyn, the controversial former U.S. Surgeon General, on Washington, D.C. She is now a pediatrician at Arkansas Children's Hospital in Little Rock. (From "Elders Leaves Her Pain Behind," in Thursday's New York Times)

Speak softly and carry...

"I go out on a limb more than I did before with business. Now when I go into business meetings, I'm thinking, 'If you guys had just half of what I have'."

-- San Fernando Valley, CA., print shop owner Frank Whitehead on the benefits of a surgical procedure that widened and lengthened his penis. (From "How a Risky Surgery Became a Profit Center For Some L.A. Doctors," in Thursday's Wall Street Journal)