Congress Passes Medicare Makeover

Last-Minute AARP Support Overwhelms Democratic Resistance

November 26, 2003
After months of secretive behind-the-scenes negotiations, a last-minute push by AARP propelled the Bush Administration's Medicare prescription-drug bill to passage. But opponents vowed to fight on and the measure's supporters may face tough questioning in the days ahead.

The first major revision of Medicare in the program's history, the complex measure will provide limited prescription coverage to some who don't now have it, but it may reduce coverage for some who do now have it.

The legislation that finally emerged from the GOP-controlled conference committee is lengthy, complex and often contradictory -- a creature of the many compromises adopted by Congress to mollify special interests, silence critics and stay within the $400 billion budget established by its GOP sponsors.

An analysis by the Department of Health and Human Services proclaims the bill will increase seniors' choices, provide prescription drug support to all seniors for the first time and reduce state spending on Medicaid. HHS also provided estimates showing that, on average, seniors will see a 50% reduction in their prescription drug spending.

The measure is to a great degree a strategic move by the GOP to take the health-care-for-seniors issues away from Democrats. It's also an attempt to exert some control over Medicare spending without harming such traditional GOP supporters as the pharmaceutical industry and physicians.

Whether the strategy succeeds politically will become evident in next fall's elections. Whether it succeeds as healthcare policy will be harder to determine and will vary widely from one individual to another.

To some extent, the Medicare makeover reflects the generation gap between today's seniors -- who grew up in the Depression and suffered through World War II -- and the not-quite-old baby boom generation.

The World War II generation is accustomed to fixed-benefit pensions and a central government that takes care of its soldiers and seniors. The more individualistic boomers see themselves as more self-sufficient and entrepreneurial and are more confident of their ability to manage their healthcare needs in retirement.

AARP makes no apologies for casting its lot with the boomers. In a New York Times interview, AARP CEO William Novelli said it bluntly: "Boomers are the future of the AARP." On his coffee table was the organization's glossy magazine, advertising stories on "amazing new sex drugs" and "where to find love."

"We had to change. We had the boomers coming and you didn't want to be perceived by the boomers as just being for old people," agreed AARP President James Parkel.

Indeed, the year-long debate over how, and whether, to restructure Medicare has created deep divisions in the aging and healthcare sectors that may take some time to heal. Here is a partial scorecard of who came down on which side of the debate: