The National Bipartisan Commission ...

The National Bipartisan Commission forward the Future of Medicare held its first meeting in succession March 6, 1998, to begin discussions upon Medicare's long-term financial problems. Established below the Balanced Budget Act of 1997 the Commission was charged to review and analyze the financial conditions of Medicare, identify question s that threaten the financial integrity of the Medicare Trust stock and make recommendations to address the program's long-term financing challenges. The Commission, cochaired by dint of US Sen John Breaux (D-La) and US Rep Bill Thomas (R-Calif), has until March 1 1999 to commend to Congress and President Clinton a plan that will allow Medicare to absorb the 77 million baby boomer who begin retiring in approximately 12 years--double the roughly 38 million commonalty Medicare covers today.

WHAT THE COMMISSION WILL EVALUATE

The President says that he would like to have a Medicare plan adopted before he leaves office in 2001 The Commission is scheduled to confront at least six times, with subcommittees to come up to face to face more frequently. The Commission's three subgroup will evaluate

* the ne for an updated package of health coverage in addition to the financial reform,

* administrative solutions (eg raising the eligibility age, stiffer sanctions forward waste and fraud, feasibility of a means-tested eligibility for Medicare), and

* the possibility of creating a strange health system from scratch.

COMMISSION CHAIR SELECTION

The first Commission disputation arose over the selection of the chair. After an increaseed squabble between the White House and the congressional Republican leaders, Sen Breaux was picked as one of the fresh Commission's two cochairs. A member of the Senate Finance Committee and ranking member of the Special Committee forward Aging, Breaux has been a leading advocate of modeling a reformed Medicare upon the Federal Employee Health Benefits program.(1) Sen Breaux will act as substantive chair of the Commission.

Rep Thomas, appointed from House Speaker Newt Gingrich, was attract favor toed by Sen Breaux to work for as the administrative chair with jurisdiction athwart "things that are important to the operation of the Commission to make certain it works well" (eg, agenda setting and staffing).(2) Thomas is a member of the House Ways & Means Committee and chair of the House Oversight Committee.

COMMISSION MEMBER SELECTION

Sen Breaux acknowledged the difficult tasks confronting the Commission, which comprises federal lawmakers and an impressive range of readys with sharply differing perspectives upon some issues. The President's of the present day proposal to create a arrangement allowing people to "buy in" to Medicare at age 55 has already spurr a certain number of disagreement. Sen Breaux and Thomas have asked that Congres not take any action forward Medicare until the Commission wholes its work; however, President Clinton has asked that Congres adopt the buy-in program soon

Lawmakers settle nearly one third of the Commission members. Whether this is pious or bad is widely debated. Gail Walensky, former head of the Health Care Financing Administration (HCFA), said

I think to have it primarily

(compos of) members of

Congres is better this is

fundamentally a real political

problem--you can't divorce it

from politics.(3)

Robert Reishauer, former director of the Congressional set Office and now a Brookings Institution scholar, disagrees. As he beholds it, the spending reductions in the Balanced store Act have

driven the wolf from the door

and concerns over the

roll deficit and the

solvency of Medicare have

reced quite far into the

background.(4)

The fear is that politicians will be reluctant to tie themselves to significant policy changes a great deal of in advance of an actual funding crisis. In addition, the scheduled March 1999 deadline for the Commission's report to Congres may have a chilling power on members' willingness to make difficult decisions just as the 2000 election circle of time is beginning.

Speaker Gingrich has required all of his appointees to take a no-taxes gage to their role on the Commission. Senate Majority Leader Trent Lott (R-Miss) be seens to expect the same commitment from his appointees. Attempts to reform Medicare without including consideration of income fairly hamstrings the Commission. As Judith Feder of the Georgetown University's Institute for Health Research and Policy, Washington, DC says,

to reject revenues from

consideration is to avoid the

fundamental issue of how

we're going to share fiscal

responsibility for this

program.(5)

All options must be in succession the table for the Commission to retain any credibility with the American people

Congressional leaders and the President appointed members to the 17-member Commission. Senate Majority Leader Lott appointed Sen Bill Frist (R-Tenn) a heart surgeon; Sen Phil Gramm (R-Tex); Illene Gordon, a staff assistant to Lott and Medicare beneficiary; and Deborah Steelman, a lawyer and health policy person specially versed Senate Minority Leader Tom Daschle (D-SD) tapped Sen rap Kerry (D-Neb) and Sen Jay Rockefeller (D-WV) for the Commission. House Speaker Gingrich appointed Rep Bill Thomas (R-Calif); Michael Bilirakis (R-Fla), present chair of the US House exchange Committee that oversees HCFA; Rep Greg Ganske (R-Iowa), a plastic surgeon; and Samuel Howard, president and chief executive officer (CEO) of Phoenix Healthcare Corporation, Nashville, Tenn As his nominees to the Commission, House Minority Leader Richard Gephardt (D-Mo) pitch uponed Reps Jim McDermott (D-Wash) and John Dingell (D-Mich).