Bush Still Has No Clue on a Medicare Drug Proposal
Obviously, the Bush Administration only has intellectual firepower on the foreign policy side (suppress that chuckle). Three years into his administration, and four years after making a campaign promise on Medicare, Bush still has no detailed proposal for extending drug coverage to seniors, how it will work, and how much coverage it will provide.
In essence, Bush's Medicare framework is a compromise between the administration's conservative ideology and its pragmatism. Facing resistance within his party -- as congressional Republicans accused the White House of bungling the plan's development and of failing to help enough elderly people afford prescription drugs -- Bush's framework is less far-reaching than some in the administration would have liked. Still, the proposal's most innovative aspects would rely on parts of the health care marketplace that have little experience with Medicare patients.
At the same time, by leaving many essential details blank, the Medicare plan diverges from the White House's approach to its other main legislative goals of recent months -- a war resolution against Iraq, adopted last fall, and further tax cuts -- in which Bush explicitly told lawmakers what he wanted them to do. Instead, the plan reverts to an earlier administration tendency to draft policy in broad strokes.
According to lawmakers and health policy analysts across the ideological spectrum, the details that Bush omitted leave basic questions about whether the White House's framework makes sense. Among the uncertainties: Would all 40 million elderly people on Medicare get enough help in paying for medicine? Are private health plans willing to take part? Can the changes Bush wants fit within his price tag of $400 billion over the next decade? And -- crucially -- would the approach save money at a time when Medicare faces severe financial strains?
Said one congressional aide steeped in the issue: "The hard questions have not been answered."
Consequently, the natives on his side of the aisle in Congress are getting restless one year before the election, and the lack of an administration proposal has allowed congressional moderate Democrats like Cal Dooley of California to lead an effort to craft their own incremental, affordable approach to providing drug coverage.
This will place Bush in the position of either opposing a detailed, probably bipartisan approach by offering his own pile of nothing, or ceding leadership on this issue to the moderates while claiming credit for signing a bill that did not have his fingerprints on it. But he already has experience claiming credit for policy initiatives he abdicated responsibility for, or outright opposed. Remember when he claimed credit for a patient bill of rights in Texas when he actually opposed it?