Bush's big gambit on Medicare
His plan may win the Senate vote Monday, but it also creates a major new social program that makes conservatives squirm.
WASHINGTON
By winning a new prescription-drug benefit for seniors, George W. Bush could recast not only the Medicare program but also his presidency - in a direction that many in his party don't like.
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The question is whether the gambit will be the decisive victory Mr. Bush hopes for, one that shows Republicans are capable of dealing with America's mounting healthcare concerns without breaking the federal bank.
It's the GOP equivalent of President Clinton's move to reform welfare. And it is prompting many similar cries of alarm from the party base. While Mr. Clinton ended a 61-year federal entitlement guarantee that his party created, Bush is adding to a federal entitlement his party once opposed.
Clinton's move shrank the welfare rolls and positioned Democrats, albeit reluctantly, more in the political center.
In a similar way, Bush's effort to provide drug coverage while also shifting many seniors into private insurance plans would be a historic change. Republicans could say they were able to deliver, after years of promises by both parties, the biggest expansion of Medicare since 1965.
But the move also carries the risk of a backlash, either from seniors disappointed that the new law doesn't go far enough to reimburse their pharmacy bills - or by Republican faithful angry that it does too much.
"This could be a real triumph of Republican politics, but it would also be a triumph of Democratic health policy," says Robert Moffit, top health-policy analyst at the Heritage Foundation, a conservative think tank.
The $400 billion set aside for a new prescription drug benefit in Medicare over the next 10 years is just a down payment, he adds. The big costs will kick in when 76 million baby boomers begin to retire in 2012.
The prospect of high and rising costs made the House's vote Saturday a cliffhanger, with 25 Republicans breaking with the White House. A win in the Senate is expected Monday, despite strong opposition from some Democrats who oppose Republican efforts to introduce an element of choice and competition with Medicare.
The plan would deliver on what has become the president's top domestic priority, just as the 2004 campaign season is taking hold. And it positions GOP congressional candidates to claim credit on an issue typically owned by Democrats.
But how the issue will play out with American retirees and taxpayers remains uncertain.
Even before new Medicare costs take hold, the Bush administration has presided over a dramatic increase in discretionary spending unrelated to the war on terrorism. These include big increases in government spending on education and agriculture. A nearly $100 billion energy bill, including subsidies for energy producers across the board, has passed the House and is expected to be taken up again in the Senate, where it failed by two votes on Friday.
With the federal deficit expected to reach half a trillion dollars this year, approval of a big new entitlement in Medicare could also be seen as a betrayal of GOP roots as the party of limited government.
"We can never out-Democrat the Democrats. If voters want bigger government, they'll return to the genuine article," says Rep. Jeff Flake (R) of Arizona, one of 25 Republicans to buck the president and vote against adding a prescription drug entitlement to Medicare.
