"I know what is going to happen," then-Maine Sen. Bill Cohen said last autumn, bemoaning the fact that although Medicare had become a hot campaign issue, no serious efforts were being made in the White House or Congress to achieve long-range reform.
Republican Cohen - now Clinton's secretary of defense - predicted that if the president were safely re-elected, "the first thing he will do" would be to call for the creation of a blue-ribbon commission to resolve the Medicare crisis.This was not reckless speculation. The commission dodge is a familiar trick to provide officials with a bit of political cover to ease the pain of making essential policy changes the public might not like. It also serves as a fine delaying tactic, putting off the day of reckoning through yet another election cycle.
Of course Cohen was correct, although off a bit on the level of urgency. It wasn't the first thing Clinton did.
But it didn't take the president long to begin calling for just such a commission to spend roughly a year studying potential structural changes in both Medicare and Social Security to avoid bankruptcy of the programs.
The presidential commission has yet to see the light of day. Two Republican and two Democratic members of Congress, impatient with White House pokiness, announced this week they would head their own study group to make recommendations for substantive reform.
It may be, however, that blue-ribbon commissions have outlived their usefulness as a cosmetic substitute for congressional and White House leadership on tough issues. They do not seem to have much impact unless a bipartisan consensus already exists for what they recommend.
Two recent panels, for instance, bombed spectacularly and have created more political chaos than clarity.
An expert panel set up to advise the National Institutes of Health on the usefulness of routine mammograms threw up its hands and said it couldn't decide whether the examination might reduce the odds of dying of breast cancer for women in their 40s. So, in effect, the experts told women to do as they pleased.
Because there is ample evidence that regular mammograms have reduced fatal breast cancer by 30 percent in women who are 50 or older, this callously casual approach for younger women created a political firestorm. Officials of the American Cancer Society and the director of the National Cancer Institute were outraged. Senate hearings were immediately demanded.
Another example of an inconclusive commission was the special panel established to take a long view of Social Security's finances and recommend ways to guarantee the system's solvency over the next 75 years.
After a two-year study, the 13 panel members split three ways, each proposing a scheme incompatible with that of the others. The panel was sharply divided about whether to invest Social Security funds in the stock market and, if so, how much, by whom, with what controls and what likely consequences.
The Clinton administration and Congress reacted as though they had just choked on poison pills and quickly promised that much more thought would be given to the subject, perhaps involving several years.
Other commissions have fared no better. Four years ago, Democratic Sen. Bob Kerrey of Nebraska struck a bargain with Clinton. In return for Kerrey's support for Clinton's original budget, the president would agree to establish a bipartisan commission on entitlements and tax reform.
That commission labored mightily and produced sweeping, courageous recommendations. For example, the commission proposed cutting entitlement programs by raising retirement eligibility ages, curbing Social Security cost of living increases and other penny-pinching measures.
But what made sense in theory was madness for political career survival; the report went into the circular file.
One of the most highly touted and visible commissions of the Reagan era was also a dud. The Grace Commission pleased conservatives in 1984 by pointing out billions in federal spending that were described as wasteful and ripe for elimination. The problem was that every so-called wasteful penny was viewed as an essential expenditure by some member of Congress. It was shelved.
The commission concept survives, however, because sometimes it does work and because politicians are always looking for ways to sidestep the dreaded day when they must risk their jobs by carrying out their decision-making responsibilities.
The classic triumph was the Base Closure Commission, which did an efficient job of singling out obsolete military bases to close. The commission's closure list then went to Congress, where it could either be accepted or rejected in its totality. That technique relieved members of Congress from having to forever defend expensive and outmoded installations that pumped money into their districts.
How useful a presidential commission on Medicare and Social Security might be is open to question.
It could play a role as part of the extensive national debate that will be necessary to shape a popular consensus behind controversial reforms which will inescapably affect the well-being of millions of Americans. But no group of neutral experts can dictate the answers to this particular issue, no matter how unanimous they might be.
That is ultimately up to the politicians, who must consider not only financial forecasts but balance the sharply contradictory philosophical approaches of the two parties.