Candidates Soft On Medicare On The Trail

John McCain and Barack Obama
Gabriel Bouys/Emmanuel Dunand/AFP/Getty Images

Comparing the Candidates

McCain: He has proposed a major overhaul of Medicare's payment system — paying health care providers not by each individual service they perform but by how successfully they treat their patients. He hopes that could serve as a model for private insurers. He also has proposed making wealthier Medicare beneficiaries pay more for their benefits, starting with the new prescription drug benefit. He voted against that program in 2003 on the grounds that it served people who didn't need it and added to Medicare's long-term financial problems.

Obama: He wants to expand Medicare, in a sense — making a Medicare-like program available to those under age 65 who do not have insurance. But he also wants to help bring down the price of drugs under that new Medicare benefit. Like most Democrats, Obama says that prescription drugs under Medicare are way more expensive than under other government programs, such as the Department of Veterans Affairs. Unlike Medicare, he notes, the VA is allowed to negotiate for better drug prices.

seniors ask questions about Medicare Drug Plan

hide captionMayer Kotlarsky, owner of The Village Pharmacy store, speaks with Albert Hagler (right), who has questions about the Medicare drug plan.

Joe Raedle/Getty Images

Medicare is almost always a big issue in presidential campaigns because the huge federal health care program is important to seniors, who vote in disproportionately high numbers.

But this year, the candidates are playing down Medicare compared to past campaigns, in part because the federal program is close to broke.

Between rapidly rising health costs and 78 million baby boomers — who start becoming eligible for the program in just two more years — both Arizona Sen. John McCain and Illinois Sen. Barack Obama recognize that the program needs to be put on firmer fiscal footing.

This may explain why both are being as soft as possible on the issue on the campaign trail.

McCain has been traveling the country quoting the former head of the Government Accountability Office, who says he is tired of "laying a $30 trillion deficit on future generations of Americans."

"In several years, 70 percent of our taxes" will go Social Security, Medicare and Medicaid, McCain has said. "That's not sustainable. And yet we continue to mortgage our children's futures."

Obama says he's not as worried about Social Security, calling Medicare and Medicaid the real programs in crisis. "If we don't deal with them soon, we're going to be making our children and our grandchildren poorer," he said.

Different Proposals On Fixing Medicare

Both candidates also recognize that fixing Medicare cannot be done in a vacuum and must part of an overall change to the health care system at large, but that's where they part company.

McCain has proposed a major overhaul of Medicare's payment system — paying health care providers not by each individual service they perform but by how successfully they treat their patients. He hopes that could serve as a model for private insurers.

He has also proposed making wealthier Medicare beneficiaries pay more for their benefits — starting with the new prescription drug benefit. He voted against that program in 2003 on the grounds that it served people who didn't need it and added to Medicare's long-term financial problems.

"People like Bill Gates, Warren Buffet don't need their prescriptions underwritten by taxpayers," McCain said. "Those who can afford to buy their own prescription drugs should be expected to do so."

Obama, on the other hand, wants to expand Medicare in a sense — making a Medicare-like program available to those under age 65 who don't have insurance. He also wants to help bring down the price of drugs under that new Medicare benefit. Like most Democrats, Obama says that drugs under Medicare currently are way more expensive than under other government programs, such as the one in Veterans Affairs.

"Now, if you take Zocor, you're paying about 10 times what those in the VA system pay, just because the VA system was allowed to negotiate for prescription drugs," Obama said. "And the Medicare benefit — we decided [we] wouldn't do it. That obviously is an enormous mistake."

Critics Skeptical Of Both Proposals

Most budget analysts, however, say price negotiations won't bring down the price of drugs very much. Health policy analyst Marilyn Moon, of the American Institutes for Research, says McCain's proposal to charge wealthier beneficiaries more probably wouldn't fix Medicare's finances, either.

"It's not going to save you a lot of money until you start to pull down what you treat as high income to a much, much lower level than most people think of as high income," Moon said. "To get substantial resources, you'd have to talk about making changes that would affect people who have incomes of 50,000 or less."

In fact, says Moon, when it comes to fixing Medicare, there really are only painful choices.

"Somebody is going to have to take a hit," she said. "It's either going to be taxpayers, or the beneficiaries of the program, or the people who provide the services. And nobody wants to tackle any of those groups, because they're all going to scream very loudly if they suddenly have to bear a lot of the burden of the future of Medicare."

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