The Medicare monstrosity

Posted: Feb 02, 2004 12:00 AM

Oops, they did it again. Appeasing the elderly vote by adding a prescription-drug benefit to Medicare will cost one-third more than the Bush administration said. Instead of $400 billion during the next 10 years, it will cost $534 billion. Secretary of Health and Human Services Tommy Thompson has said he knew the figures were going to leap higher, but he didn't say anything to members of Congress: "I did not tell them because it was not my responsibility." So, exactly whose responsibility is it to tell the truth about entitlement spending in the Bush administration? Maybe it should hire someone.

The Medicare bill passed the House by only five votes at 5:53 a.m. on Nov. 22. The White House twisted arms all night long, and, in one case, supporters of the bill allegedly resorted to an act of near-bribery to strong-arm a reluctant congressman. Put together the hardball tactics and the dishonest numbers, and passage of the Medicare bill was one of the smelliest legislative acts since ... well, since the last energy, farm or highway bill.

The Medicare revision -- up 30 percent in just two months -- is just a taste of the entitlement cost explosion to come as retiring baby boomers soon begin to fatten themselves on all the benefits of the Geriatric State. Instead of trimming back and reforming retirement benefits, the administration and members of Congress added to them last year. Ronald Reagan used to say that calling Congress drunken sailors was unfair to drunken sailors. It still is. Drunken sailors might spend freely, but at least it's their own money and at least they don't live in fear of elderly voters complaining that they aren't getting enough free drinks.

The Medicare revision is, in one sense, not news. One fixed law of political physics is that entitlements always expand. At its creation in 1965, Medicare was projected to cost $9 billion by 1990. It clocked in at a cool $67 billion instead. The dynamic is always to make entitlement benefits more generous and to extend them to more people. This is what has happened with Social Security, Medicare, Medicaid -- and will inevitably happen with the prescription-drug benefit.

The race has already been on for a while. In 2000, Bush proposed a $198 billion reform of Medicare that would include a prescription-drug benefit. His proposal last year was estimated at $400 billion. According to The Washington Post, Medicare administrators were estimating it would cost $150 billion more than that as early as June last year. Meanwhile, Ted Kennedy wants to close the law's so-called "doughnut hole," a gap in coverage that would, shockingly, require seniors to pay some of their own drug bills. That will cost billions more. The alternative Democrats were offering last year, and would like to revive, would cost $800 billion.

Who says there's no difference between Republicans and Democrats? The partisan battle lines have been drawn in a fight between disgustingly excessive elderly entitlement spending and fantastically disgusting excessive elderly entitlement spending. The only hope to pull the nation back from the brink is another political constant: the sense of pampered greed of many senior voters.

We have been here before. In the late 1980s, Congress passed a catastrophic coverage bill that included drug coverage. In the space of a year, the estimate for the cost of the drug benefit grew from $5.7 billion to $11.8 billion. Seniors revolted against the act, alarmed at how much they would have to pay under it, and it was quickly repealed. When they learn how much of their drug bills they still will pay when the new Medicare law kicks into effect in 2006, they might revolt again. In the ashes, perhaps Congress could then pass a limited bill to help low-income seniors who actually need it. It's either that or watch costs spiral ever upward in a way that would make even a drunken sailor dizzy.