The following editorial appeared in today's Washington Post:
The Medicare drug benefit that Texas Gov. George W. Bush proposed the other day would do recipients less good than the rhetoric in which it was packaged suggested, and the structural changes the benefit is meant to induce in the rest of Medicare could do the overall program long-term harm. The benefit would not be trifling. For many poor and near-poor recipients, it would represent a solid gain. But millions of other recipients with modest incomes for whom drug costs are a major burden would likely receive no benefit at all. Were Mr. Bush to have his apparent way, Medicare would meanwhile be transformed into a program in which the government would have less liability than now, and no benefits would be as clearly guaranteed.
Mr. Bush would not have the government provide drug coverage directly. Rather, he would have it help recipients buy private insurance. That is in keeping with the impulse of his party -- and some Democrats -- to reduce the federal role in providing health care. They argue that reliance on the private sector would be more efficient -- encourage innovation, hold down costs, etc. But though they don't acknowledge it, the step back from government that they propose would create at least as many problems as it would solve.
The candidate and his advisers say all Medicare recipients would be eligible for the subsidized insurance he suggests. That's absolutely true; the only problem is, they couldn't all afford it. He means-tests the program, but not generously enough. The subsidy he offers all but the least well-off recipients is too shallow. Estimates vary, but millions who lack drug coverage now would remain without it if this program were to be put into effect. This from a candidate who is simultaneously proposing hundreds of billions of dollars in tax cuts that would decidedly not be means-tested; they would go disproportionately to people at the very top of the income distribution. Imagine if he were to move just a little money from one purpose to the other.
It may well be that, as Mr. Bush and others argue, a system in which the government gave people chits to buy their own insurance could be more efficient than traditional Medicare. But such a system could work only if the chits were of sufficient size; for too many recipients, Mr. Bush's would not be.
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