Bill Frist’s ‘Big Vision’ for Medicare

Published January 1, 2003

Heart surgeon and U.S. Senator Bill Frist (R-Tennessee) is stepping into a political swamp wrought with alligators: overhauling Medicare.

Most Republicans are aware they need to deliver prescription drug benefits to the nation’s senior citizens in the next two years. They have repeatedly promised to do so, and now they control both Congress and the White House. Democrats, who assert the Republicans simply paid lip service to the issue to get through the elections, are certain to hold conservative feet to the fire if they fail.

The Big Vision

Frist plans to release an initial blueprint of a proposal for broad, long-term Medicare reform by the end of January. He said the proposal would include increased competition among private health plans for Medicare beneficiaries. The proposal will also suggest development of a new health care infrastructure, which could include information and management systems to assess outcomes and allow physicians and patients to exchange information.

Frist, who this month assumes a seat on the Senate Finance Committee, which has jurisdiction over Medicare issues, has said, “Republicans should do more to reform Medicare than simply add a drug prescription benefit.”

As reported in Health Care News, the House passed in June 2002 a $350 billion Medicare reform bill that included a prescription drug benefit and give-back provisions for providers, but the Democrat-controlled Senate failed several times to pass similar legislation.

Frist said he hopes to pull together all the interested parties and address Medicare reform and the “big-vision” thinking of where the administration wants to see Medicare 10 years from now.

Plenty of Potholes

On hearing of Frist’s “big vision,” the New York Times reported many Democrats oppose any reduction of the role of the federal government in Medicare. According to Representative Ben Cardin (D-Maryland), a member of the House Ways and Means Committee, “If they’re trying to reduce the federal government’s risk, reduce the federal government’s costs, and get seniors into private insurance through vouchers, that’s a nonstarter for most Democrats and we’ll fight that.”

In addition, the Times reported Senator Charles Grassley (R-Iowa), who will chair the Senate Finance Committee in the 108th Congress, and Representative Bill Thomas (R-California), who chairs the House Ways and Means Committee, also will weigh in on proposed Medicare reforms. The Ways and Means Committee has jurisdiction over Medicare issues in the House.

Frist asked the Times, “Are we ready for really bold change now?” then answered his own question, “I think we are.” The reason, he added, was “driven by the demographics in part, but also by the fact that we have a leader [in President Bush] who’s willing to do big things and bold things.”

Frist acknowledged he probably wants to go further than his party’s leadership wants to go, since historically Republicans have been hurt politically when they have tried to overhaul Medicare, a program covering 40 million elderly and disabled Americans.

In the mid-1990s, House Speaker Newt Gingrich’s efforts to streamline Medicare and extract $270 billion in savings sparked a political firestorm. Bill Clinton, as President, helped form a bipartisan commission to examine the future of Medicare, headed by Senator John B. Breaux (D-Louisiana), but the commission’s recommendations went unheeded during the Clinton years.

“I’m an eternal optimist,” said Breaux, who like Frist advocates offering the elderly a private-sector alternative to the single-payer Medicare arrangement.

Scott McClellan, former White House spokesman and now chief of the Food and Drug Administration, said Bush has long supported modernizing Medicare by adding prescription drug benefits and by moving toward a more competitive model, allowing the elderly to stay with traditional Medicare or choose among a variety of private insurance plans.

Conrad F. Meier is managing editor of Health Care News.