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The Illusion of the Latest Medicare Reform

Just about every major industrial democracy in the world has a single-payer system to provide medical services. The payer is the government that, in turn, is financed by taxes paid by those who someday may require medical care.

The United States has a multi-party system involving insurance companies, health maintenance organizations (HMOs) and the federal government. Commenting on our present system, Geraldine Dallek, a consultant on Medicare issues for George Washington University, is cited by the Washington Post as saying: “Lock the nation’s smartest health care economists in a room and ask them to come up with the most complicated health insurance system imaginable — and they wouldn’t even come close to the byzantine system we have in place in America today.” And, she adds, it now has been made more complicated by “passing a Medicare prescription drug benefit that will make it harder, not easier, for the nation’s senior citizens to navigate health care.” To navigate the murky waters, a senior citizen would need to have a Ph.D. in pharmacology, accountancy and jurisprudence.

However, there is a saving grace in the last act of Congress in this matter: The changes do not become effective until 2006. And then, it will still not be applied universally. It will be tried out in six as-yet-unnamed metropolitan areas — until 2010.

Of course, between now and 2006, there will be a presidential election. If Bush loses, the new president may well ask Congress to revoke the present Bush plan. If Bush wins, he may push to go through with the plan. But even so, in the midterm election of 2006, he may lose control of Congress since, as a rule, midterm elections to Congress generally run against the party whose man is in the White House.

If, however, the GOP still holds on to a majority in Congress, there is another presidential election in 2008 when we may still be wrestling with disorder in Iraq and Afghanistan, and restless and reckless jihadists pouring into old and new trouble zones. And should the American economy continue to sink — as it is, despite the phony statistics on “recovery” that we get from the White House and it cheerleaders — the GOP, if it is still in power, is not likely to hang on by 2008. But if it does, there still is the midterm election of 2010.

All of the above is a lengthy — perhaps too lengthy — suggestion that between now and 2010, much may and will happen that will block the present plan from ever becoming the law in practice.

Now comes the obvious query: If this is so, why didn’t the administration put its proposals into law, effective as of today? Perhaps they knew it would ruin them by 2004 or in the subsequent midterm election. So why take chances? As it is, the Republican administration has pre-empted the Democratic drive for affordable prescription drugs under Medicare and stolen the Democrats’ thunder. Put bluntly, they wrote a scenario to win an election by creating the impression that they are improving Medicare while, in truth, doing nothing but fooling the people. But, as Abraham Lincoln reputedly put it, “You can fool some of the people all of the time, and all of the people some of the time, but you cannot fool all of the people all of the time.” The cynical circus entrepreneur P.T. Barnum had his variation on this principle: He allegedly said that if he could fool some of the people all the time and all the people some of the time, both he and his business would prosper. Could it be that President Bush follows in the footsteps of Barnum and thereby converts Medicare into Muddiedcare?

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