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Fixing Medicare isn't this easy

At a time when Medicare is facing insolvency, is it prudent to begin talking about adding benefits?

President Clinton thinks so, which is why he is proposing a plan to pay the cost of prescription drugs for the nation's elderly. Currently, Medicare pays for drugs only if the patient is hospitalized. But the president offers little help as to how the government would pay for this benefit, saying only that the program would pay for itself because it would keep people from having to enter hospitals for more expensive care.A prescription drug plan is guaranteed to play well in the next election. By some estimates, only 23 percent of the people who rely on Medicare have supplemental insurance that covers prescriptions. Realistically, however, glossing over the costs won't be so easy. The soaring price of drugs is leading the way in the highly inflationary health-care industry.

A congressional committee, chaired by Sen. John B. Breaux, a Louisiana Democrat, and Rep. Bill Thomas, a California Republican, came up with its own plan that would provide each beneficiary a fixed amount with which to buy a private or public health plan. Perhaps this is not as ideal as a government plan that would cover all prescription drugs for premiums that would rise by as little as $10, but it recognizes the overriding truth that benefits cost money and that market competition is the best way to hedge inflation.

Certainly, Clinton's assertion has some validity. Some modern medicines, administered under the care of competent physicians, can reduce the need for costly surgeries. But industry experts say it is difficult to generalize to the point where an entirely new benefit could be said to virtually pay for itself.

Clinton's plan also calls for Congress to earmark 15 percent of the expected budget surplus for Medicare improvements over the next 15 years. That coincides with the time remaining until, most analysts believe, the program will go bankrupt.

But Medicare isn't the only looming crisis on the horizon. Social Security is a much bigger problem, and the federal government already is borrowing from the Social Security trust fund to make the budget appear as if it is in a surplus. Does the president really want to make Social Security pay for Medicare? Does he really want to rely on the completely unrealistic promise of unlimited economic expansion as far as the eye can see?

The president deserves credit for beginning to tackle Medicare. However, this is a problem that deserves a careful and realistic analysis, not a quick fix based on slogans and votes.