By this time next year, congressional Republicans predict, senior citizens on Medicare will be flocking to managed care plans for their health concerns.
Yet what is good enough for America's retirees doesn't pass muster with many of the politicians themselves. When their own health is at stake, the lawmakers steer clear of HMOs. They prefer plans that let them choose their doctor and hospital when and where they want.Take Rep. Gerald Solomon, the powerful Rules Committee chairman who has Blue Cross insurance and Medicare as a backup. When he needed medical attention recently, Solomon chose the prestigious Leahy Clinic.
"A great deal of recovering from an illness is the confidence you have in your own physician," said the 65-year-old former Marine. "I believe very strongly in personal choice."
Overwhelmingly, the top Republican policymakers and many others in Congress choose traditional fee-for-service medicine for themselves and their families.
"It is always an irony about lawmakers that they often don't live in the same world and don't have to follow the same laws," said Robert Friedland, director of the National Academy on Aging. "During the debate on Medicare it was believed the solution was going to be managed care, yet most of them are not in anything close to a traditional managed-care plan."
Members of Congress have other medical perks, including a doctor stationed in the Capitol and easy access to the National Institutes of Health and Walter Reed Army Medi-cal Center. Senate Republican leader Bob Dole, a decorated veteran seriously injured in Italy 50 years ago, said he pays his Blue Cross premiums but gets extensive care through the Army.
And when the lawmakers retire, the taxpayers will continue paying a hefty portion of their health insurance premiums.
"This puts to shame the notion that what's good for the goose is good for the gander," said Ron Pollack, executive director of the advocacy group Families USA. "Ex-tolling managed care for others is not necessarily a prescription that members want to follow for themselves."
Republicans say the real appeal of their recently approved Medicare revamp is that 37 million elderly and disabled people will have new choices. If the bill becomes law, Medicare recipients, just like members of Congress, would receive a booklet listing the health plans available in their region. Republicans stress that senior citizens will be allowed to remain in the current Medicare program.
Solomon, one of the few Medicare beneficiaries serving in Congress, said he knows "a lot of senior citizens don't like managed care because they'd be forced to go to certain doctors. . . . That's why I fought so hard that the Republican plan be at least as much personal choice."
"If it's good enough for members of Congress then it's probably good enough for our American seniors," said Rep. Cliff Stearns, a Florida Republican who has chosen Blue Cross for his family.
But if the senior citizens behave the way the politicians do, the GOP's hope of saving billions through Medicare reform has little chance of success. That's because the Republicans are counting on big savings by steering the elderly into cheaper health plans.
"The reality is that with the extent of budget cuts in this bill and all these carrots to lure physicians outside traditional Medicare it will be very difficult for seniors to stay in traditional Medicare," said Gail Shearer, health policy director at Consumers Union.
House Speaker Newt Gingrich predicts that over the next seven years at least half of all Medicare recipients will leave the current fee-for-service system and join managed care plans. In fact, Gingrich is so confident of managed care's attractiveness, he recently predicted the old-fashioned fee-for-service Medicare will "wither on the vine."
But when asked what insurance he has, the Georgia Republican paused and said: "Blue Cross, I think; my wife handles it."
The same goes for virtually all of the high-ranking Republicans who helped write the Medicare bill.
"We're slow to catch up," explained Sen. William Roth, the Finance Committee chairman who oversaw the legislation in the Senate and is enrolled in Blue Cross.
About 43 percent of federal workers, including members of Con-gress, chose the Blue Cross and Blue Shield plan this year. It costs $102 a month for a standard family policy. Routine visits to the doctor cost $10, and mail-order prescription drugs are available for $12. There is no deductible for most hospital treatment, although outpatient services such as chemotherapy and dialysis cost $25 a day after paying a $200 annual deductible.
Compare the politicians' plan with Medicare. Medicare recipients do not pay premiums for physician coverage but pay a $100 deductible and 20 percent of most doctor visits. Hospital coverage, called Part A, charges patients $46.10 a month in premiums and a $716 deductible for each 60-day visit.
Medicare does not cover prescription drugs or eyeglasses. Most Medicare recipients also purchase supplemental coverage, called Medigap, to help cover those costs.
In the complex world of health care delivery, there are different levels of consumer choice. Savvy politicians realize their Blue Cross policy can be described as a step toward an HMO, but there are real differences.
Technically speaking, the Blue Cross policy is labeled a Preferred Provider Organization, or PPO. But that means patients visit a range of doctors who join the Blue Cross network. If a person visits a doctor outside the network, the patient pays a little extra.
The Blue Cross PPO for members of Congress is a far cry from others in the nation and nothing like HMOs, where doctor choice is severely limited and patients are screened by a "gatekeeper." But in the Washington, D.C., area virtually every doctor accepts Blue Cross patients, so the lawmakers' choices are essentially limitless.
Pam Drellow, a spokeswoman for the Blue Cross & Blue Shield Association, said most doctors are eager to join their network serving 34 million federal workers and their families.
Patients such as the politicians "don't have access problems," she said. "Providers want that business."
After the National Academy on Aging studied dozens of health plans offered by the federal government, Friedland concluded the Blue Cross policy was, in effect, a fee-for-service plan with "virtually no restrictions."
Much of this year's Medicare debate has focused on premiums, with Republicans asserting the government should not pay more than the current 68 percent. Yet a survey by the Office of Personnel Management found that on average the taxpayers cover 72 percent of federal employees' health insurance.
And as long as a lawmaker served at least five years, the taxpayers will continue paying that cost into retirement - another benefit few Americans can look forward to in their later years.
Some large companies subsidize health benefits for retirees, said Friedland. But the number has been declining and doesn't include workers at smaller firms. As he put it: "The vast majority of workers do not have post-retirement medical benefits."