* Create new medical savings accounts, combining insurance and a savings mechanism. If the government pays $4,000 for an average beneficiary, for example, that person could pick an insurance plan costing just $2,000, with an annual deductible of $2,000. The $2,000 saved this way could be placed in a tax-free account, available to pay medical bills.
* Provide deep reductions in payments to hospitals that train doctors, and those caring for large numbers of poor people.
* Reduce sharply the growth rate in payments to doctors and other providers.
The Senate Finance Committee's bill, approved last month, takes a somewhat different approach and asks more of a sacrifice from beneficiaries. It would boost the annual deductible for doctor bills, now $100, to $150 next year, and then add another $10 a year until 2002. It also would allow enrollees to get rebates if they can obtain insurance coverage for less than the premiums allowed by the government.
Rep. Bill Thomas (R-Bakersfield) said his party's blueprint is a "bold initiative" that will "protect, preserve and strengthen Medicare."
The GOP Medicare juggernaut has all but obscured the unprecedented degree of unity that Democrats have achieved in recent days--speaking with one voice in a way that they have not done all year. Some are predicting that this cohesion, however ephemeral, could nevertheless cause a reduction in the spending cuts that Republicans want to impose.