MEDICARE’S FINE PRINT

The reported deal among leaders of the Medicare conference in Congress leans toward the House version of the massive, complex bill, raising serious questions about its helpfulness to seniors. But of at least equal importance is the lack of time most members of Congress will have to consider this dramatic overhaul of the nation’s primary health-care safety net and the question of whether they should vote on crucial legislation that they will barely get to see, much less analyze, before they vote.

The tentative agreement among Senate Majority Leader Bill Frist and House Speaker Dennis Hastert and Sens. Max Baucus and John Breaux would require the Medicare program to compete against private plans starting in 2008 on a six-year, large-scale project. Maine Sens. Olympia Snowe and Susan Collins have been properly suspect of plans to privatize Medicare because they know that rural regions would lose out from lack of competition under such plans. They should also doubt the effectiveness of benefits in an earlier draft of the legislation, which would require a beneficiary to pay 25 percent of drug costs from $275 to $2,200 a year.

These seniors would then get no coverage until their cost rose to $3,600, when almost all the cost would be covered. The gap between $2,200 and $3,600 is called “the doughnut hole,” and while it existed in both House and Senate plans it has grown larger in conference.

Committee Chairman Bill Thomas apparently was left out of the agreement and, while the White House would certainly pressure him to sign on, many other conservative House members would not – they want full privatization. On the left, Sen. Edward Kennedy has said he would not support anything “that will undermine [Medicare] and force seniors out of their relationship that they have with their doctors and health delivery systems into an untried, untested, unworkable program.”

With neither end happy about the legislation and with almost no one seeing more than a broad outline of the $400 billion proposal, Congress should go slowly. Its deadline for adjournment – Nov. 21 – makes that difficult, as does the lack of an agreement on a huge energy bill and the five remaining spending bills in the Senate. Congress cannot complete all this work in a week, or at least it cannot complete it all well. The reforms planned for Medicare, however, are so serious that Congress should not risk passing a bill because it is a politically popular move and then later discovering the proposal’s ill effects, accidental or otherwise.

The choice for Congress is to remain in session until the work is completed properly. A few added days into the Thanksgiving week would give them more time; the first week of December would likely give them enough, unless the other bills consume the time. Staying in session would make members of Congress unpopular with their exhausted staffs; passing a Medicare overhaul without fully debating its provisions could make them even less popular with millions of seniors.