Medicare 'Savings' Will Haunt Bush

The Bush administration is about to have a problem. Big time. They're violating the most basic rule of politics: Don't let the voters know what's going on. In politics, you can do anything you want, as long as you do it to people who don't vote. That can mean people who don't have the right to vote, or those who have the right, but don't use it. That's why the voting age is 18, but the drinking age is 21.

Take a look at the map of the United States and notice which states tend to be liberal and which are conservative. (By the way, somebody should do something about those words, since the old definitions no longer apply. It's the liberals who want to conserve, and the conservatives who are trying to remake everything. Truth in labeling doesn't apply to politics or politicians; never has never will.) Maybe it's circular reasoning, something about good newspapers needing a large reading population to make money so that the best papers are in large cities &endash;- but progressives seem to do better in areas where there's at least one really good newspaper. That's what happens when people have a way of finding out what's happening. Of course the Bush administration is doing all it can to keep things secret, but information has a way of leaking out. That's especially true when things start getting close to home.

And it is close to home. Newspapers are good at covering discrete events, like wars and baseball games, but they may be slow in recognizing social trends. Even so, most of the news media have reported on the problems facing both Medicare and Medicaid. The increasingly mislabeled health care "system" is falling apart. Of course it's not a major political liability if Medicaid recipients can't get their prescriptions filled because that's a program for the poor, and the poor don't vote. Of people living around the poverty level, only about 33% actually vote, compared with 57% voter turn-out among people with incomes over $75,000. Fewer than half the people around the poverty level are even registered to vote, compared to about 77% for the over $75,000 group. These numbers are taken from census figures, which systematically undercount the poorest people. From a political viewpoint, Medicaid is a safe target.

But recently, Medicare, the program for the elderly, has been running into trouble too. The president has underfunded Medicare, and cut back on reimbursement rates in spite of increases in health care costs. Physicians have refused to take new Medicare patients because the reimbursement rates don't cover expenses. People on Medicare are voters. Real voters. Voter registration in the 65 to 74 year old age group is much higher than among the population as a whole. Even people at the poverty level have an 84% registration rate, and among people with an income over $75,000, the rate goes to 87%. Almost 66% of the people in this group actually cast ballots. Even if your news comes from the Washington Times, you'll start noticing when Grandma can't find a doctor. You'll really sit up and take notice when you can't find a doctor yourself. Meanwhile, Medicare is reducing the amount it pays to providers, and providers are responding the only way they can, by not taking Medicaid and Medicare patients.

Why would any politician take on a voting block that dwarfs the NRA, and is only going to grow as the Baby Boomers age? Issues like oil drilling in Alaska and snowmobiles in National Parks may be forgotten at election time, but being turned down by an MD because she can't afford to treat you is going to strike home. Having your local hospital shut down for lack of money gets noticed. Having your Medicare HMO close down, or being unable to afford health insurance are all issues that get attention, and votes.

Paul Krugman, the New York Times' economic columnist, has opined that the administration is cutting back on health care payments in order to hide the cost of the Bush tax cut. Maybe. But that may be only part of the story. Ask the question: Why give a big tax cut to people who already have tons of money at the expense of alienating a massive group of people who are going to vote at the next election?

Maybe the Party of Lincoln doesn't have much of a goal except to break the government so that it can't be fixed. Ronald Reagan, he of the self-financing tax cuts, ran up such huge deficits that it took Bill Clinton two terms to put the budget back in working order. As a result, no major social programs were created during the Clinton administration.

Even so, when Clinton left office, we were looking at projected surpluses, paying off the national debt, and dreams of universal health care, prescription drug coverage and better schools. It didn't take W very long to turn things around and guarantee federal deficits for years to come. The latest plan, to make the tax cuts permanent, would make the deficits permanent.

Former Sen. Bob Kerrey was quoted as saying "With budget caps gone, income taxes already cut and bipartisan enthusiasm to spend considerably more on defense, it is safe to say that the era of surpluses was like passing through a village in Nebraska: We passed through it before we realized we were there"

Recommended reading is David Brock's Blinded By The Right. Yes, Brock's book has led to a revival of Lerner & Lane's musical classic "How Could You Believe Me When I Said I Loved You When You Know I've Been a Liar All My Life?" &emdash; but what he says fits. If Bush I's legacy is Clarence Thomas, Bush II's "vision thing" may be perpetual budget deficits.

Whatever the reason, plan to stay healthy. It's the only thing you can afford.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

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