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A Crowded Bandwagon for Medicare Fix

It's a scramble for seats on the overhaul panel. Lawmakers join the hunt, despite prospects for unpopular decisions.


WASHINGTON — Thankless tasks usually don't have many takers. But in the peculiar world of Washington politics, people sometimes fight for the right to make enemies.

A pitched battle is underway among doctors, consumer groups, hospitals and members of Congress to occupy the 17 seats on a new commission charged with overhauling Medicare, the nation's health insurance program for the elderly.

The commission will ponder such proposals as increasing premiums across the board, making richer beneficiaries pay a bigger portion of Medicare's $210-billion annual price tag, raising the eligibility age to 67 and reducing benefits for the millions of baby boomers who will start enrolling in 2010.

Any of those options would call on millions of Americans to either pay more and/or receive less as the price of keeping Medicare solvent. Sensible politicians and lobbyists are normally loath to prescribe bitter medicine like that. Yet the prospect of a backlash has not slowed the scramble for seats.

"The lobbying is intense, just intense," says Tricia Smith, a senior federal health lobbyist at the 32 million-member American Assn. of Retired Persons. "They've promised 167 more positions than there are under the law."

The job of making appointments, which is to be completed by Monday, is divided among Capitol Hill's GOP leaders, who pick eight panel members, congressional Democrats, who choose four, and President Clinton, who names four. The chairman will be chosen jointly.

The White House is deeply divided on how to fill its four slots. Clinton is considered likely to name Bruce Vladeck, who recently left his post as director of the Health Insurance Financing Administration, and is said to be looking closely at former House member Tom Downey (D-N.Y.), who is a friend of Vice President Al Gore's.

Among the other contenders:


Despite conventional wisdom that lawmakers want to avoid slashing medical care for the elderly, dozens of members of Congress are lobbying for slots. So far, it appears likely that lawmakers will fill at least half of the 17 appointments.

That could increase the commission's influence, since lawmakers can gauge in advance the policies they can sell to their Capitol Hill colleagues. Still, in the absence of a crisis--and Medicare is not slated to run out of money until 2008--it remains hard to believe that politicians will be willing to cast the tough votes.

"You need to have politicians because they are the ones who . . . know what it takes to push it into legislation," says Mark Weinberger, a former chief of staff to the 1994 Bipartisan Commission on Entitlements and Tax Reform.

Two senators already have been named: John D. "Jay" Rockefeller IV (D-W.Va.) and Bob Kerrey (D-Neb.). Others considered likely to land a seat include Reps. William M. Thomas (R-Bakersfield) and Michael Bilirakis (R-Fla.), and Sens. Phil Gramm (R-Texas) and Bill Frist (R-Tenn.).


With so many seats already spoken for, the battle becomes even more intense among the many health care interest groups, each of which is worried that the businesses they represent stand to lose billions of dollars if their representatives are not in the room.

House Speaker Newt Gingrich's office has a thick folder stuffed with letters on behalf of hospital executives, managed-care company officials and doctors representing almost every specialty. House Minority Leader Richard A. Gephardt (D-Mo.) has been besieged with similar requests.

The American Medical Assn. is conducting a serious lobbying campaign on behalf of its president, Dr. Nancy Dickey, and a former president, Dr. Stormy Johnson.

Managed-care firms are applauding the likely appointment of Deborah Steelman, a health care lawyer with a number of managed-care clients. Steelman, who was a staffer in both the Ronald Reagan and George Bush administrations, is on the short list of both Senate Majority Leader Trent Lott (R-Miss.) and Gingrich (R-Ga.), according to staffers close to the process.


AARP, which represents much of the Medicare population, could receive a seat from an unexpected source. Gingrich, who tends to oppose the AARP's legislative agenda, is considering appointing AARP Executive Director Horace Deets, with whom the speaker has a strong personal rapport, according to Gingrich confidants.

Meanwhile, Third Millennium, a nonpartisan group representing Generation X interests, argues that if the elderly are to get a seat on the commission, then the people who are going to pay the taxes that support Medicare ought to as well. The group is pushing two members, one Democrat and one Republican.

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