The politics of Medicare reform become more complex by the day but always are driven by deep and still-unresolved ideological fissures.

The question that always is at the center of the debate over health care in this country is whether government or individuals should be in charge of managing resources and decisions.

That remains the big divide in the Medicare debate, and it is very, very difficult to resolve, especially since the question is obscured in hundreds and hundreds of pages of complex legislation that make it almost impossible to engage the public in an open debate over this pivotal issue.

The White House had hoped to get a Medicare bill passed before the August recess to keep momentum going. But much of the energy that could have been devoted to the overall bill in July was consumed instead by the battle over Rep. Gutknecht’s drug importation bill.

With 87 Republicans joining 155 Democrats to pass the measure, the debate is not over yet. Drug importation still is one of talk radio’s hottest topics, and tempers continue to flare, showing a nerve has been hit.

This August, members of Congress will be at home while senior staff – and policy advisors – give up summer vacations to continue to toil over differences between the big House and Senate Medicare bills.

What members hear from their constituents while they’re home may well determine the measure’s ultimate fate. Reaction to the drug benefit provisions will be the focus of attention. Will seniors be grateful for any progress on a Medicare drug benefit? Or will they become increasingly concerned about the cost and the potential loss of their existing coverage?

More and more studies will pour out examining the details, editorials and commentaries will become increasingly polarized, and politicians will be jockeying to find out if their fates will be better with or without a bill.

When Democrats decided in May to play ball in developing a bi-partisan drug bill in the Senate, the calculation clearly was that senators up for reelection – from both parties – would pay a price if this Congress fails to enact a drug benefit.

But the calculation could change if enough of the 75% of seniors with drug coverage begin to fear that the benefit Congress has constructed is worse than what they have now, and if millions more Americans decide that the government’s complex drug benefit is not worth the price.

This year could be the best chance ever to begin to modernize the Medicare program, but if the political will to pass a big bill collapses, Congress could decide instead to refocus on a benefit for low-income seniors without coverage to get something – anything – passed before the 2004 elections.

Pollster Bill McInturff of Public Opinion Strategies has argued for several years that Congress doesn’t have to do everything at once, only show progress and a sincere effort. Perhaps a bit of thinking outside the box is in order as Washington’s crazy pace slows a bit. It would be wise to keep the options open.

Grace-Marie Turner

The politics of Medicare reform become more complex by the day but always are driven by deep and still-unresolved ideological fissures.

The question that always is at the center of the debate over health care in this country is whether government or individuals should be in charge of managing resources and decisions.

That remains the big divide in the Medicare debate, and it is very, very difficult to resolve, especially since the question is obscured in hundreds and hundreds of pages of complex legislation that make it almost impossible to engage the public in an open debate over this pivotal issue.

The White House had hoped to get a Medicare bill passed before the August recess to keep momentum going. But much of the energy that could have been devoted to the overall bill in July was consumed instead by the battle over Rep. Gutknecht’s drug importation bill.

With 87 Republicans joining 155 Democrats to pass the measure, the debate is not over yet. Drug importation still is one of talk radio’s hottest topics, and tempers continue to flare, showing a nerve has been hit.

This August, members of Congress will be at home while senior staff – and policy advisors – give up summer vacations to continue to toil over differences between the big House and Senate Medicare bills.

What members hear from their constituents while they’re home may well determine the measure’s ultimate fate. Reaction to the drug benefit provisions will be the focus of attention. Will seniors be grateful for any progress on a Medicare drug benefit? Or will they become increasingly concerned about the cost and the potential loss of their existing coverage?

More and more studies will pour out examining the details, editorials and commentaries will become increasingly polarized, and politicians will be jockeying to find out if their fates will be better with or without a bill.

When Democrats decided in May to play ball in developing a bi-partisan drug bill in the Senate, the calculation clearly was that senators up for reelection – from both parties – would pay a price if this Congress fails to enact a drug benefit.

But the calculation could change if enough of the 75% of seniors with drug coverage begin to fear that the benefit Congress has constructed is worse than what they have now, and if millions more Americans decide that the government’s complex drug benefit is not worth the price.

This year could be the best chance ever to begin to modernize the Medicare program, but if the political will to pass a big bill collapses, Congress could decide instead to refocus on a benefit for low-income seniors without coverage to get something – anything – passed before the 2004 elections.

Pollster Bill McInturff of Public Opinion Strategies has argued for several years that Congress doesn’t have to do everything at once, only show progress and a sincere effort. Perhaps a bit of thinking outside the box is in order as Washington’s crazy pace slows a bit. It would be wise to keep the options open.

Grace-Marie Turner