KICKING OUT THE JAMS:

Bush Adds Managed Care to Debate on Drug Benefit (Vicki Kemper, January 29, 2003, LA Times)

President Bush did far more Tuesday night than signal the beginning of a new round in the debate over a Medicare drug prescription benefit.

By proposing to tie eligibility for the benefit to participation in a managed-care plan, Bush also changed the rules of the high-stakes political battle.

Last year, Senate Republicans and Democrats came tantalizingly close to agreement on a compromise benefit package. After weeks of back-room politicking and serial votes over the details of the benefit and how much it would cost, in the end all that separated the partisans was a disagreement over how the benefit should be delivered.

Senate Republicans, along with their counterparts in the House, wanted private insurance companies and pharmacy benefit managers to administer the benefit, while Democrats wanted Medicare -- that is, the government -- to do it.

But now, with Republicans in control of Congress, and congressional Democrats lining up to run against him in 2004, Bush has upped the ante.

Instead of using the drug benefit to bring some private-sector competition into the Medicare program, he wants to make prescription coverage the driving force for a more thorough privatization of Medicare itself.

If you were a bettor you'd have to lay big money that he'll fail in this effort. But it's the essence of great leaders that they change the terms of debate. Love them or loathe them, FDR's "greatness" lay in changing the United States from a country in which government was distrusted into one in which it's depended on. LBJ's lay in his putting that government on the side of the nation's most despised and oppressed citizens. Reagan's lay in his assertion that not only was the Cold War winnable but that our victory was inevitable and just. Bill Clinton had a chance to be great. He could have been the President who brought free enterprise principles and structures to the Welfare State. But, other than welfare itself, which the GOP shoved down his throat and Dick Morris got him to swallow, Clinton just didn't have the vision or the stomach for the task. George W. Bush appears to have vision and stomach to spare, but it's unimaginable that the rest of his party will rise to the moment, while they would certainly have done so had they had Clinton for cover.

The '90s--what a waste.

Posted by Orrin Judd at January 29, 2003 8:01 PM