Thomas Oliphant is on the money when it comes to the Medicare Issue. "Medicare is an especially big enchilada."

Past haunts Dean on Medicare issue
The Boston Globe - By Thomas Oliphant, 9/30/2003

Had Dick Gephardt been more politically correct last week, he would have rebuked Howard Dean for standing with Senator Pete Domenici of New Mexico on proposed Medicare cutbacks in the 1990s or with then-Representative John Kasich of Ohio. To those bosses of the newly Republican budget committee in Congress, he could have added the GOP revolutionaries running the House Ways and Means Committee -- Bill Archer of Texas and Bill Thomas of California.

Newt Gingrich, however, was a lightning rod for disbelief -- a distraction, really. Dean expressed wounded shock and horror that anyone would link him to the former speaker, who in turn tried to link slashes in eligibility and other restrictions on Medicare beneficiaries with a whopping tax cut for high-income Americans.

The truth, however, is that as a conservative Democratic governor, Dean really did do what Gephardt says he did, and his shifting attempts to wiggle off that hook have made his conduct an issue in a Democratic race that grows more serious by the week.

Ever since Gephardt -- followed by John Kerry -- raised the Medicare issue nearly a month ago, Dean has expressed wounded horror at the guilt by association, deplored the tactics of "Washington politicians," and declared Gephardt's criticisms "flat-out false."

Actually, they are flat-out true. That becomes even more troublesome now that Dean has come up with still another explanation for his Medicare behavior -- Bill Clinton himself. Dean's inaccuracy here is also instructive.

I have been watching this subplot to the Dean phenomenon for two months, ever since Dennis Kucinich nicked him for having supported an increase in Social Security's eligibility age -- a criticism that Dean also initially denied and then flipped on. It has happened on Social Security, on trade, on middle-class taxes, on budget-balancing policies.

Medicare is an especially big enchilada. For Gephardt to raise it is of special significance in Iowa, where he and Dean are in a dogfight in a place that has the fourth-highest concentration of retired people in the country. Dean will plead guilty to having supported a slowdown in Medicare's rate of spending growth (from 10 to 7 percent annually) -- an innocuous-sounding, almost accountant-like budget position. In fact, the proposal he supported would have restricted eligibility, called on some retired people to pay more, and used force more than incentives to require participation in managed care.

Gephardt himself might be guilty of excessive force in using Gingrich's name the way he has, but the Medicare proposal was one-half of the centerpiece of the former speaker's infamous Contract With America (the other was the tax cut), and the fight over it led to the weeks-long shutdown of the government at perhaps the most climactic domestic policy moment of the Clinton presidency. Dean's support was especially important to the Republicans as the House prepared to pass its version of the proposal in 1995, but he never pulled it back as the White House-Congress war escalated.

In the last few days, sensing the political fallout, Dean has come up with a fresh explanation: He was doing something that Clinton supported and actually signed into law. This is even more misleading, an apples and oranges mixture that makes what happened two years later sound like what happened in 1995-96.

Nothing could be further from the truth. What Clinton signed in 1997 was a law that finally produced a tax cut for ordinary families (introducing the child tax credit, subsequent increases in which Dean now says he wants repealed), and containing spending cuts to pay for it. It is often referred to as the Balanced Budget Act, but in fact it was the booming economy that produced the huge surplus at the end of the '90s. This law, more accurately, produced a tax cut that was responsibly funded.

The spending cuts included a large bite out of Medicare but not the same kind of bite the Republicans fought for with Dean's help in '95. This time around, instead of attacking the beneficiaries (which Clinton opposed), it reduced Medicare payments to providers like hospitals, nursing homes, and physicians. By bipartisan consensus it went too far, especially in its harmful effect on large teaching hospitals, and much of the money has since been restored.

Dean now says his willingness to go after middle-class entitlements reflected the deficit crisis of the mid-'90s, but this is also a misleading position. The fact is that the deficit reduction program enacted in Clinton's first year had already put the country on the right road. What the Republicans were pushing in '95 was revolution.

Moreover, the reemergence of fiscal crisis has made Dean's views in the mid-'90s relevant: He has said Medicare should again be on the table if he is president.

Bottom line: Gephardt and Kerry have a legitimate point, and Dean will have trouble expanding his remarkable base to the elderly and to voters of moderate means unless he does a more forthright job of facing up to his past.