Michael Arnold Glueck and Robert J. Cihak
Tuesday, July 8, 2003

In "The Medicare Mess" we described some of the problems with the Medicare "reform" bills passed by the U.S. House and Senate last month. We also need to review how the bills shorten the fuse on the demographic time bomb facing Medicare and other entitlements.

Since President Franklin D. Roosevelt established the first Social Security entitlement in 1935, Americans are living longer, healthier lives. At the same time, Americans are having fewer children on average than previous generations. This has resulted in a demographic time bomb, with fewer than four workers currently paying taxes into Social Security and Medicare for every recipient. In 1950, 16 workers were putting money into the system for each recipient.

In the latest temperature spike of this "entitlement fever," the U.S. Senate and House passed separate bills late last month calling for a new Medicare prescription drug entitlement. Will President Bush stick by his original call to link such a benefit to reforms that provide more choice, including private health plans, for Medicare recipients, and for competition among Medicare insurance providers?

The bills that the House and Senate passed last month open up another huge sinkhole in Americans' lives. They create another open-ended entitlement which purportedly would cost "only" $400 billion over the next 10 years. Similarly optimistic past predictions of the cost of other new federal entitlements have proven grossly low.

And rather than helping Americans, Congress' proposals will cause more pain and suffering for Medicare recipients, doctors, taxpayers and their children. Instead of reforming Medicare, lawmakers may bankrupt it.

Andrew J. Rettenmaier and Thomas R. Saving of Texas A&M University, writing in the Wall Street Journal, estimate the bills could create an additional unfunded liability of $7.5 trillion, or $25,000 for every American alive today, adjusted for inflation.

For all their cost, the measures don't include President Bush's proposal for Medicare reform modeled after the Federal Employees Health Benefits Program (FEHBP) provided to congressmen and other federal employees, as we noted in our previous column.

Bush would include a "Medicare Advantage" system, which would allow Medicare recipients to have health plan choices and insurance companies to compete and offer innovative plans.

Even though a June 21 Zogby poll showed 82 percent of voters favor a private health plan option for Medicare recipients, Congress is intent on precluding that choice.

Given Congress' record, it's no wonder the legislation its branches passed is inconsistent with the health-care choices that Congress gives itself and the health-care choices the president says he wants for Medicare recipients.

Members of the House and the Senate will meet as a conference committee to try to iron out the differences between the two bills. We hope President Bush has the courage to defuse this entitlement booby trap while continuing to seek genuine reform. More specifically, we hope he can convince the Conference Committee to make some real reforms.

If the conference committee fails to significantly improve the legislation and Congress passes the resulting bill, the president should veto the current mess and tell us why.

No wonder author Philip Gold calls the result of such political pressures on American medical care a "Disaster by Design."

Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a former president of the Association of American Physicians and Surgeons.

Contact Drs. Glueck and Cihak by e-mail.

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