Addressing the American Medical Association this week, President Bush laid out the broad contours of his plan for revamping Medicare. He’s proposing to fix something that basically isn’t broken, offering in its place a sulfurous brew of bad economics and bad social policy. The best that can be said about it is that it doesn’t stand a chance of enactment. America won’t stand for it, and Congress knows it.

The president wants to introduce free-market competition into the Medicare system, offering seniors a choice between the traditional fee-for-service plan and various private plans to be marketed by insurance companies with government subsidies.

The impetus behind Medicare reform is prescription drug coverage, currently a gaping hole in seniors’ healthcare. New advances during the last generation have created a vast array of life-saving medicines, but at an enormous cost. Politicians of both parties have been tussling for years over the best way to close the gap.

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Bush has seized on the drug crisis as an opening for his larger plan to privatize seniors’ coverage. In his plan, drug coverage is the bait to entice seniors to switch into private plans. Those who switch would receive comprehensive coverage for their drug needs, which average thousands of dollars a year. Those who opt to stay in the traditional Medicare system would receive limited drug discounts — between 10% and 25%, according to the administration — as well as a $600-per-year subvention for the needy.

Bush argues that bringing market economics into Medicare will improve patients’ medical care. “When insurance providers compete for a patient’s business, they offer new treatments and services quickly,” he told the medical gathering. “If they don’t, the patient, the customer, will look for better services elsewhere.”

That may sound good on paper, but there’s no reality to back it up. Medical care is a complicated matter involving scientific decisions most patients are hard-pressed to grasp. That’s why the doctor-patient relationship is so crucial to good medicine. The steadily growing power of big insurance companies in the field during the last generation hasn’t empowered either patients or doctors. It’s simply transferred decision-making into the hands of faceless corporate bureaucrats.

Medicare, the federal health insurance program for the elderly and disabled, is one of the most popular and successful social programs ever enacted in this country. Since it was signed into law by Lyndon Johnson in 1965, it has transformed the lives of millions of seniors by removing a shadow of fear. It stands as a symbol of society’s ability to improve the lives of individual citizens when the will exists. That symbolism is the real reason for Bush’s plan. He and his fellow ideologues of the right want to dismantle the government’s health plan — not because it doesn’t work, but because it does.

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