The landmark Medicare reform package President Bush steered through Congress last week seems more likely to intensify than resolve the debate in the 2004 campaign over how to provide health care and retirement security for seniors, analysts in both parties say.
The legislation itself promises to be a flashpoint, with Bush touting its new prescription drug benefit as proof that he has delivered a “compassionate conservative” agenda, and his Democratic rivals portraying the bill as a giveaway to drug and insurance companies.
Just as significant, Republicans close to the White House say Bush’s success at forcing through Congress structural Medicare reforms will stiffen his resolve to pursue even more ambitious changes in Social Security -- a potentially more explosive issue in next year’s election.
“This gives him the capacity to run on reforming Social Security,” one GOP strategist familiar with White House thinking insisted.
The debate over entitlement reform is sharpening as seniors have become an increasingly fluid constituency, less firmly attached to either party and more influenced by the same constellation of values issues that are driving many younger voters.
“In the past, you were dealing with a monolithic bloc, and it was Democratic,” said Susan MacManus, a political scientist at the University of South Florida, who has studied voting patterns among seniors. “Now you are looking at a diverse block of voters.”
That means the struggle between the parties to define the prescription drug benefit next year is likely to be only one factor, and possibly not the major factor, in determining how seniors vote.
“Good or bad it’s not going to be as decisive as people think,” said Ruy Teixeira, a Democratic public opinion analyst.
“The prescription drug issue, per se, has always been less potent than Democrats believe. I think Democrats can turn this bill so it isn’t a positive for Bush, but even if they don’t, that doesn’t make seniors a lock” for Bush, he said.
An enduring myth in American politics is that seniors vote reliably Democratic, largely because of the party’s support for Medicare and Social Security, the two pillars of the social safety net for the elderly.
But as MacManus noted, the picture has been more complex in recent years. From the 1980s through the early 1990s, most seniors supported Democrats in congressional elections, according to network exit polls. But the Republican presidential candidate won a majority of seniors in every presidential election from 1972 through 1984.
In 1992, Bill Clinton carried seniors by a decisive 12-point margin over George H.W. Bush; but two years later, seniors tilted toward the GOP in the midterm landslide that carried Republicans to a majority in the House and Senate.
The next year, Clinton revived his presidency by beating back an attempt from congressional Republicans to reduce the growth in Medicare spending. Yet in the 1996 election, while Clinton’s performance improved among younger voters, his margin with seniors dropped to just 4 percentage points over Republican Bob Dole, and a narrow majority of seniors again backed Republicans for Congress.
In 2000, former Vice President Al Gore touted his support for a Medicare prescription drug benefit relentlessly but failed to expand Clinton’s 4-point advantage among seniors. (Gore lost seniors in Florida, where he spent the most time selling his prescription drug plan.)
Nationally, seniors broke narrowly for Democrats in the 2000 congressional elections and edged back toward the GOP two years later, according to exit polls.
For 2004, the key lesson from this history may be that far from voting solely on the giant federal programs that so intimately affect their lives -- Social Security and Medicare -- many seniors are also moved by the broader events shaping any election, from the backlash among cultural conservatives against Bill Clinton in 2000 to homeland security in 2002.
In the Los Angeles Times exit poll in the 2000 presidential race, for instance, as many seniors cited moral values as Social Security as the principal reason for choosing between Gore and Bush. Less than half as many seniors cited prescription drugs as the principal motivation for their vote than either morality or Social Security in that survey.
A Times Poll this month found seniors leaning strongly toward a Democrat over Bush in 2004, largely because the poll shows them to be much more critical of Bush’s policies in Iraq than younger Americans.
Republicans are confident that the drug issue will be more relevant next year than in 2000 because Bush can tout the passage of legislation creating the prescription benefit, while Gore could only promise to pursue one.
“What Bush is going to be able to do and say is he delivered on a key issue that was important,” said Republican pollster David Winston. “That is going to have a positive impact on seniors.”
Bush is also likely to benefit from a chorus of well-heeled supporters.
In 2000, Gore’s drive to sell his plan for a prescription drug benefit was offset by a huge independent advertising effort from the pharmaceutical industry critiquing his approach. In 2004, said GOP pollster Bill McInturff, not only the drug industry but also the Republican National Committee, the Bush reelection campaign, groups representing health-care providers, and the AARP, the leading seniors’ lobby, could all run advertising campaigns to support Bush’s plan for providing seniors with drug benefits.
“That’s a lot of weight,” McInturff said.
Even so, many Democrats appear confident they can discredit and neutralize the prescription drug issue as an asset for Bush. While 11 Democratic senators voted for the legislation, every Democratic presidential candidate has already condemned it, quickly developing several lines of argument likely to remain prominent through 2004.
Because the prescription drug benefit doesn’t begin until 2006, both sides recognize that it is their arguments, rather than actual experience, that will most shape public verdicts on the plan in next year’s campaign.
Down one track, Democrats are arguing that the bill provides insufficient benefits for average seniors. Down a second, they maintain that the bill will threaten traditional Medicare benefits by tilting the program toward greater reliance on private insurance companies. And finally, they are portraying the legislation as a giveaway to health-maintenance organizations (because it provides lucrative new subsidies to participate in Medicare) and pharmaceutical companies (because it precludes the federal government from negotiating for lower drug prices).
Tricia Enright, the communications director for presidential hopeful Howard Dean, says Democrats may highlight the bill as much as Bush in 2004, using it to contend the administration is too sympathetic to special interests.
“You add this bill with Halliburton and Bechtel in Iraq, and the debacles with Enron and WorldCom, and this is not going to be the easy sell that they expect,” Enright said.
In response, Bush is certain to portray the legislation as a cornerstone of his effort to modernize the giant entitlement programs, providing seniors with more choices.
Bush also is likely to use the achievement as the foundation for renewing his case to restructure Social Security to provide workers the option of diverting part of their payroll taxes into individual investment accounts that they could invest in the stock market.
Like the Medicare package, Bush will present his Social Security plan as a way to expand choices for seniors and more effectively use market forces to provide social benefits. “They have at the heart of it the same sort of underlying dynamic,” said one senior Republican familiar with White House thinking.
Beyond its direct effect on seniors, the prescription drug bill could provide Bush with a valuable symbol to try to convince all voters that he is “a different kind of Republican” who is pursuing a “compassionate conservative” agenda.
In that way, McInturff said, the Medicare bill may help Bush shake off traditional party stereotypes in the same way Clinton benefited from signing welfare reform in 1996.
“The Democrats’ entire thesis is that Republicans do nothing but help rich folks,” McInturff said. “Every time the Democrats say that [next year] we’ll say, ‘Huh? We’re the party that just passed the largest expansion of Medicare for two generations.’ ”