Two Midwestern senators - one a Democrat and the other a Republican - connect important dots in the health-care debate.
In this town, where consistency of purpose is in scarce supply, Sens. Robert Kerrey, D-Neb., and John C. Danforth, R-Mo., are using the health-care debate to repeat a point they made earlier this month as leaders of the Bipartisan Commission on Entitlement and Tax Reform: Federal entitlement programs are eating up the federal budget.On the Senate floor, Kerrey and Danforth warn that Congress in the rush to expand health benefits shouldn't forget that the other goal of reform is to control soaring health-care costs. In other words, think twice before you create more entitlement programs.
Entitlement programs - including Social Security, Medicare, Medicaid, veterans' benefits, federal retirement programs, food stamps and aid to families with dependent children - have two vivid characteristics.
First, they are the fastest-growing parts of the federal budget.
For example, the Congressional Budget Office predicts that Medicare spending is likely to jump from $143 billion this year to $395 billion a year in the next decade.
Spending on all entitlements is expected to surge from $800 billion this year to more than $1.5 trillion in 2004, the CBO says.
Second, entitlement programs - which take their name from the fact that they automatically pay benefits to everyone who's eligible - are wildly popular and spawn well-organized constituencies. They've become politically untouchable because politicians who say "no" usually don't win re-election.
It's this sensitivity that led President Clinton - at Kerrey's behest - to create the commission to make recommendations on how to control spending for entitlements.
Appointing "non-partisan," "blue-ribbon" commissions is a time-honored Washington technique to re-direct political heat away from Congress and the White House. Such commissions also may serve the useful purpose of giving political courage to presidents and lawmakers to follow through on recommendations.
Danforth notes that every pending health-care reform proposal - whether sponsored by Sen. George Mitchell, the Democratic leader, or Sen. Bob Dole, the Republican leader - would create at least one new entitlement: subsidies for low-income people to help them purchase health insurance. Mitchell's plan would add other entitlements, such as helping pay for prescription drugs and paying for home health care.
In his opening remarks in the health-care debate, Danforth pointed out that the soaring costs of entitlement programs like Medicare, plus the growing interest on the $4.6 trillion national debt, will eat up all federal tax revenue by 2012.
In that year, other government spending for such programs as the FBI or the Border Patrol or federal courts would have to be paid for with borrowed money.
Against this background, Danforth argued, we can't afford to be taking on new spending programs.
Kerrey complained that the focus on broadening health coverage "subordinates the promise of restraint or cost containment to the promise of free health care."
Legislation aimed at controlling costs will be introduced by three Democrats: Sens. Byron L. Dorgan of North Dakota, David Pryor of Arkansas and Russell D. Feingold of Wisconsin.
They are upset that Americans pay vastly more for drugs than consumers in other nations pay for the same drugs.
They want a new law requiring the Department of Health and Human Services to publicize the wholesale prices of the 200 biggest-selling prescription drugs in the United States and compare them with the prices of the same drugs in at least 12 other industrialized nations.
The senators also want to prohibit the drug makers from charging Medicaid - the federal-state health-care entitlement program for the poor - drug prices higher than 25 percent more than the average price charged in foreign countries.
Despite their effort, the goal of cost control has been lost in the current debate. Late in an election year simply doesn't provide the kind of environment Congress needs to deal with such issues.
It's possible that the Senate and the House could eke out a slender program by thin margins in each body. But to be effective, any reform program should have broad political support. We should honor Thomas Jefferson's advice that large enterprises shouldn't be set in motion by slender majorities.
The time has come to proclaim a modest victory: 1994 will go down in history as the start of a healthy national debate about medical coverage and costs. Build on this and try again next year.