The Democrats Medicare Disaster

IN 1993, during the congressional debate over Bill Clinton’s health care reform bill, right-wing pundit William Kristol, advising Republicans seeking to torpedo the effort, issued a memo warning that if the bill passed, it might revive the Democrats’ reputation “as the generous protector of middle-class interests.” Therefore, Kristol concluded, the GOP had to do everything it could to stop it.

Republican pollster Bill McInturff wrote, “one of the most important predicates for Republican success is not having health care pass.” The GOP–and crucially, many conservative Democrats–conspired to undermine support for the Clinton plan. And in the atmosphere of White House defeat and public disappointment that followed the plan’s defeat–the Democratic Congress didn’t even bring it to a vote–the Republicans swept the 1994 midterm elections.

Comparing the GOP’s ruthlessness in 1994 with the Democratic collapse in last month’s vote authorizing a prescription drug benefit under Medicare tells a lot about the real nature of liberalism and its chief vehicle, the Democrats.

Given the terrible provisions of the law–from billions in pork to the medical industrial pharmaceutical complex to the first steps towards privatization of the program–it would have been right and defensible for Democrats to kill the bill at all costs. Why hand Bush a victory on a “Democratic” issue, especially when the bill is a fraud that will undermine Medicare?

No doubt, the millions the pharmaceutical and insurance industry invested in politicians on both sides of the aisle helped woo some Democrats. But it’s important to recognize that the Democrats had already boxed themselves in.

After Clinton’s program crashed and burned, the Democrats deliberately scaled back their agenda on health care. So instead of an overhaul of the U.S.’s bloated, inefficient and unequal health care system, Democrats campaigned for a weak list of guidelines for health maintenance organizations (“the patients’ bill of rights”) and on adding a drug benefit to Medicare.

Early in George W. Bush’s administration, liberals like the late Sen. Paul Wellstone explicitly gave up on the fight for a comprehensive national health care system. By scaling back their goals, the Democrats made it much easier for the GOP to agree that it too wanted to add a prescription drug benefit. And when the Republicans pushed through a bill filled with poison pills intended to unravel Medicare–and leave millions of seniors actually worse off–enough Democrats could be found to sign on to it.

After all, the goals of Democratic health care policy had been so narrowed that enough Democrats could convince themselves that this bad bill was “a step in the right direction.” It was likewise with the issue of Medicare privatization.

Some liberal Democrats rightly objected to the bill on the grounds that it would lead to Medicare privatization and the forcing of seniors into HMOs. But the Clinton-Gore administration had already set the precedent for this. In fact, Clinton’s health care reform bill envisioned the total “HMOization” of the health care system.

Later, in his battles with Gingrichites in Congress, Clinton struck a pose of defending Medicare against right-wing ideologues. Yet the fine print of the bills he signed cut billions from Medicare and encouraged seniors to leave traditional fee-for-service Medicare to sign up with HMOs.

Soon, seniors found themselves paying more out-of-pocket for their care, and HMOs greatly cut back on services. HMOs dropped more than 2 million elderly patients between 1998 and 2002. Even when the Democrats ran the Senate from 2001 to 2002, they increased subsidies to hospitals and HMOs instead of pushing a program that have would have actually helped seniors.

So this year, when the corporate lobbyists lined up for billions more in subsidies, enough Democrats continued to do what they had been doing for years–ante them up. With a timid incrementalism that has become synonymous with modern-day liberalism, the Democrats paved the way to their own debacle. And millions of seniors will pay the price

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