A MEDICARE TEST

The Senate’s clash of views over whether the government or private insurers should provide a Medicare prescription drug benefit is frustrating, especially so to those who have been working on the issue for several years and are now looking at an end-of-summer deadline to pass something or, perhaps, wait until after the next presidential election. But the debate is important, not only for this benefit, but for shaping the look of other health care programs.

The Democratic plan sees the government expanding its role in Medicare; a bipartisan plan that also includes independent Sen. Jim Jeffords and that Sen. Olympia Snowe helped write, lets private insurers carry most of the coverage. There are other differences as well, over co-pays and deductibles, premiums and covered drugs as well as the total cost – the bipartisan plan is considerably closer to the amount budgeted. But members of Congress are accustomed to compromising on money issues; the question of public vs. private gets into their beliefs of how government should operate.

Medical care rapidly is becoming like education – seen as a right of citizenship and making the expanded role of the government likely. But that does not mean health care must fit into the public-education model. Competition among private insurers can bring efficiencies absent in government; the trick is to ensure the program is carried out as intended, demanding a specific set of coverage requirements for qualified insurers, a cap on costs and consistent oversight to ensure access.

A Medicare drug benefit built through a public-private partnership could be a test case for other health benefits, including coverage for the uninsured. Time is short this session – Congress is scheduled to adjourn Oct. 4 – but both parties could emerge with a major win if they can come to agreement on such a test. Certainly, even if the test fails going forward with it is better than waiting several more years.