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Don’t Rush Medicare Overhaul Debate : Solid ideas, not sleight of hand, are needed as Congress seeks to cut cost of crucial program

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House and Senate Republicans are having a hard time agreeing on how best to restrain Medicare’s soaring costs to help meet their target of a balanced federal budget within seven years. But that still leaves them miles ahead of the Democrats, who appear only now to have realized that Medicare is in deep financial trouble.

True, President Clinton has talked about shrinking Medicare’s costs by about $124 billion by the year 2002, but that’s less than half of what the Republicans say they want to cut over that term. Now Senate Democrats are rushing to put together their own proposals, which they say would reduce spending by $89 billion. But in the absence of concrete and doable ideas, these numbers are just so much air. In the case of the Republicans’ proposed $270-billion cut, we see little more than a politically convenient tool for reaching their zero-deficit budget goal on paper. The numbers game is of no help to the public. What should be shaping up as a sober, informed and essential debate over a central social program and the fastest-growing segment of the budget is instead, typically, becoming little more than an abusive, partisan, sound-bite-driven hollering match.

We don’t know whether Republicans and Democrats--or, for that matter, Republicans and Republicans--can find common ground on Medicare costs and financing. But a couple of facts ought to serve as a starting point for discussion, to help define the problem and so point to possible remedies.

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First, this highly popular program, which covers 33 million people over age 65 and 4.5 million more disabled people, consumes far more dollars than was ever envisaged. One cause is inflation, or in the case of health care costs, hyperinflation. Another is the fact that people are living longer and older people represent a growing percentage of the population. As a consequence, Medicare’s hospital insurance trust fund, which is financed mainly by payroll taxes, is headed toward exhaustion.

Second, everyone involved in the Medicare system--consumers and providers alike--is going to have to accept unwanted changes. It’s unavoidable that Medicare recipients will have to pay higher monthly premiums for physicians’ services. Probably they will also soon see strong incentives to move into managed care programs, in which half the working population is enrolled. On their part, health care providers seem certain to face stiffer competition that will force down their charges.

Major reforms in how Medicare works can’t be rushed through Congress in a few weeks, as some Republicans have proposed. They demand--and deserve--full and careful examination and debate. For all the rhetoric, they’ve so far had neither.

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