July 26, 1999

The President Visits Michigan

by Craig Ruff

President Clinton came to Lansing. He talked about the future of Medicare and empathized with concerned citizens. His goal—to shore up Medicare to protect the health of future generations of seniors—seems straightforward and sincere. However, the process of making Medicare solvent has brought out the best and worst of American politics.

Fixing Medicare does not rest on the shoulders of philosophers, economists, and ethicists. If it did, we probably would have a plan in place, notwithstanding all the tough issues involved. Instead, a solution rests with politicians, who are driven by personal and partisan aims that often create conflict between and among the players involved, and even within themselves.

Conflicting Agendas

The president knows that extending Medicare’s solvency will bring him praise from future historians. He cannot prevent the future scorekeepers of his presidency from beginning their portraits with the word "impeached." He can only hope that a solid victory on a huge domestic matter will add some luster to his career. In the roaring ‘90s, overwhelmingly characterized by a sense of ease and complacency, about the only matter left to vex America is the insolvency of Medicare on the horizon. Ergo, for his legacy’s sake, the president badly needs a Medicare fix.

Similarly, Democrats also need Medicare. They see it as a device to help them regain control of the U.S. House of Representatives (and possibly the Senate) in the 2000 election. From their perspective, the election equation of 2000 boils down to: GOP inaction on Medicare + a high level of public anxiety about Medicare’s future = Democrats recapturing the House. Democrats are not likely to fret over their party leader’s search for veneration. ("Legacy, schmegacy!" Or, as the English writer Lytton Strachey once said, "What’s posterity ever done for me?")

However, there will be no Medicare fix before 2001 without Republican acquiescence. If Clinton needs the fix for posterity’s sake, he must pound out a settlement with his partisan enemies. Ironically, if Clinton’s victory is won in this manner, Democrats may find that their plans to use the issue as a rallying point in the 2000 elections have eluded them, and Republicans will have handed over an enhanced legacy to the guy they sought to evict from office.

The Medicare debate is a war between immediacy and the future. The conflict will not be resolved until the inevitable clash between the political aims of 2000 and those of 2010, namely, partisanship and statesmanship (not to mention the conflict between private and public interest), is reconciled.

The Real Issues

Certainly there is sincerity behind the President’s public goal of Medicare solvency, just as there is sincerity behind his private goal of redemption. Furthermore, he genuinely wishes the Democratic Party success in 2000, despite his push to fix Medicare before the election. But sincerity aside, the desires of political parties and personalities are driving a policy process that should be based on far more complex considerations, including the following:

• Medicare is very much about the benefits to and burdens placed on children, workers, and retirees. How solvency is approached is a matter of deciding which generation of Americans should be society’s priority. For example, the cost of two months of today’s total Social Security and Medicare benefits equals the yearly total private and public investment in educating and caring for children from birth up to kindergarten.
• Containing costs must be balanced against the cost of protecting—and perhaps expanding—medical benefits. Can the Medicare system’s future solvency be protected while adding prescription drug coverage?
• Active workers and retirees may be required to make sacrifices. Is today’s worker willing to pay more in Medicare withholding? Is today’s retiree willing to accept benefit reductions?
• Should we trade off some of today’s prosperity for tomorrow’s security? Should the government tap federal budget surpluses to prefund Medicare instead of giving Americans tax cuts or investing in other social programs? If so, how much should be reserved?

The Future

On one hand, congressional Republicans have stubbornly ignored the possibility of tapping federal surpluses for long-term Medicare relief, and they have alarmed Americans by representing federal standards (like patients’ rights) as a socialist undermining of states’ rights. On the other hand, congressional Democrats have pursued Medicare solvency without thought of relieving the substantial burden on the very taxpayers who paid for the budget surpluses, and they have frightened consumers with horror stories of cost containment and managed care. Instinct—as opposed to reason—is inseparable from politics. As long as Republicans intuit that their best strategy is to be pigheaded, and Democrats remain convinced that their best hopes for success are through demonizing, the impasse will continue.

For the future of Americans, I hope that the president’s visit to Michigan elevates the public debate, reduces partisan obstinacy, narrows the gap between short-term, self-interested pragmatism and long-term public good, and brings Americans closer to Medicare solvency. Partisan gains and personal legacies I could care less about.