Bush revised his previous scheme that would have restricted full drug benefits to those who signed up for managed care or private medical plans. The latest proposal offers limited drug benefits to those who remain in Medicare.

The president’s shifts are part of the tactical maneuvering among Democratic and Republican politicians as they discuss moves that would put more of the costs of health care onto the backs of working people. The framework of the bipartisan debate is to treat Medicare not as a social entitlement, but as one possible "choice" among other health-care plans.

"All seniors should be able to choose the health care plan that best fits their needs," said Bush in a March 4 speech to the American Medical Association (AMA). He proposed a yearly $600 subsidy to "low-income" Medicare recipients to help pay for prescription drugs. He also recommended placing an annual limit on the out-of-pocket expenses they incur. Bush did not define that limit, although White House officials have previously stated that Medicare beneficiaries might have to spend up to $7,000 of their own money to buy prescription drugs.

About 60 percent of Medicare recipients have some type of drug coverage. That includes the Medicaid program providing medical insurance for those considered to be earning low incomes; company-provided health benefits; individually purchased health insurance; and the Medicare option called Medicare+Choice.

The latter scheme, established under the Clinton administration in 1997, involves health-maintenance organizations (HMOs) and other managed-care plans. It covers about 13 percent of those receiving Medicare benefits. Over the past years, however, the HMOs have been dropping Medicare patients from their rolls with the explanation that the scheme is unprofitable for them, denying coverage to at least 2.2 million people.  
 
Medicare funds cut under Clinton
Clinton’s Balanced Budget Act in 1997 called for chopping funds allocated to Medicare, including cuts in payments to health providers. Medicare cut payments to doctors by 5.4 percent last year. At the March 4 AMA meeting Bush called for a 1.6 increase in this amount. The American Academy of Family Physicians reported last year that 17 percent of family doctors have stopped taking on new Medicare patients.

Medicare is a government-funded health and hospital insurance system available to U.S. citizens age 65 or older, young people receiving Social Security benefits, and the disabled. It covers a total of 40 million people. Eligibility does not depend on income, while the coverage pays for medical treatment in hospitals, nursing homes, and home health services.

Medicare and Medicaid, which were signed into law in 1965, were won as byproducts of the mass civil rights movement and other social battles of the 1960s. Medicaid was passed as an amendment to the Social Security Act, enacted in 1935 under the pressure of a powerful upsurge in labor struggles.

Bush’s Medicare "reform" proposals constitute an extension of the bipartisan assault on social entitlements spearheaded by Clinton, who signed the 1996 Personal Responsibility and Work Opportunity Act. That law eliminated Aid to Families with Dependent Children (AFDC), a federal entitlement under the Social Security Act that guaranteed cash assistance to poor families with children.

Meanwhile, a recent study released by the Robert Wood Johnson Foundation estimated that 75 million people lacked health insurance at some time over the past two years. Last fall the Census Bureau reported that 41 million people went without medical coverage for all of 2001.

As a result of the economic slowdown and higher joblessness, a rising number of middle class and working people don’t have health insurance. Even during the "boom" years of the 1990s, the number of people uninsured rose by nearly 10 million.  
 
 
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